Gastrointestinal Dominant Henoch Schönlein Purpura in Children: A Report of Two Cases

Background: Henoch Schönlein Purpura (HSP) is the most common vasculitis in children, characterized by purpura, arthritis, gastrointestinal involvement, and nephritis. Gastrointestinal symptoms that appear before the onset of purpura may delay diagnosis and increase the risk of serious complications. Objective: To report two pediatric HSP cases with predominant gastrointestinal manifestations without initial purpura, emphasizing the diagnostic challenges and the importance of early detection to prevent complications. Case presentation: Case 1: A 10-year-old boy presented with fever, severe vomiting, abdominal pain, and dysuria without initial purpura. Palpable purpura appeared on the second day, confirming IgA vasculitis. The patient improved after intravenous hydration, corticosteroids, antibiotics, and vitamin D supplementation. Case 2: A 6-year-old girl presented with vomiting, severe abdominal pain, and high fever without purpura at admission. Purpura appeared on the third day, confirming IgA vasculitis. The patient showed clinical improvement following supportive care and corticosteroid therapy. Conclusion: Henoch–Schönlein Purpura with predominant gastrointestinal manifestations is relatively rare and often leads to misdiagnosis at the early stage, requiring a more careful diagnostic approach.