Atypical bullous Henoch–Schonlein purpura – A case report

Henoch–Schonlein purpura (HSP) is the most seen vasculitis in children which presents as a multisystem disorder. The most common presentation is in the form of palpable purpura on the lower limbs, abdominal pain, renal involvement and arthritis. However, in some cases, HSP may present with atypical symptoms, which poses a diagnostic challenge. We discuss the case of a 10-year-old male child with an atypical presentation of HSP. The child presented with vesiculobullous lesions over bilateral upper and lower limbs and fever, which was initially diagnosed as recurrent varicella. Tzanck smear showed inflammatory cells, skin biopsy revealed leukocytoclastic vasculitis with immunoglobulin A deposition and a diagnosis of atypical bullous HSP was made. The child was started on antihypertensives and steroids, following which he recovered well. The case highlights the importance of recognising or ruling out bullous HSP amongst its differentials, providing supportive care and evaluating the need for corticosteroid treatments.