ABSTRACT
@#Henoch- Schonlein purpura (lgA vasculitis) is the most common vasculitis in the pediatric population. It usually affects the skin, synovia, gastrointestinal tract, and kidneys. It usually presents as a palpable purpura. The occurrence of hemorrhagic bullae in children with HSP is an uncommon presentation. We present a case of an otherwise healthy 9-year-old male with a three-day history of erythematous maculopapular lesions over the lower extremItIes which progressed to violaceous plaques with central hemorrhagic bullae affecting the bilateral lower extremities, buttocks and arms. Odynophagia and intermittent abdominal pain were present. Histopathology revealed small vessel leukocytoclastic vasculitis and direct immunofluorescence (DIF) showed granular deposition of lgA and fibrinogen along the walls of the papillary dermal blood vessels. The patient was successfully treated with prednisone at 1 mg/kg/day and showed resolution of lesions within 1 week of treatment with no recurrence at 1 month follow-up. We stress the importance of having a high index of suspicion in these atypical presentations in order to prevent delay in diagnosis and achieve maximal treatment gains.