Henoch-Schonlein Purpura in 1-12 years old Children In Sulaimaniyah City , Kurdistan Regional Government Of Iraq


  • Sherko Babakir Mina
  • Hayder Fakhir


Background: Henoch-Schönlein purpura is an acute immunoglobulin A (IgA)–mediated disorder characterized by a generalized vasculitis involving the small vessels of the skin,  gastrointestinal (GI) tract, kidneys, joints, and rarely the lungs and the central nervous system (CNS). Objectives: An attempt to identify the characteristics of this disease that is considered as quite common problem in our city, to identify the epidemiological, clinical, laboratory features and complications of HSP in our locality and to find the mode of treatments used by pediatricians and trying to uniform the management in a scientific way. Patients and Methods: Sixty five patients with HSP hospitalized in Sulaimaniyah pediatric Teaching Hospital in Kurdistan/ Iraq were included in this retrospective study from 1st of January 2013 to 31st of  December 2014; they were selected by  Case sheets based on the diagnosis of HSP at discharge time. Results: Of 65 patients, 37 (56.9%) were boys and 28 (43.1) were females, with a male to female ratio of 1.3:1. The patients’ ages ranged from (2 to 12) years, with a mean of 6 years. Approximately 61% of cases were presented during winter and spring. Upper respiratory tract infection preceded HSP in (36.9%) of the patients. The main clinical features included skin rash (100%), skeletal manifestation (66%), gastrointestinal manifestation (70.8%), renal involvement (26.16%), and Genital involvement (5.4%) in males. Fecal occult bloods were positive in 10/29(34.5%) of the patients. Forty one (63%) patients received corticosteroid therapy. Conclusions: There were no major differences in the epidemiological and clinical criteria of HSP in Sulaimaniyah with that most of similar studies done elsewhere. GIT involvement more common than skeletal involvement. Many patients had been treated with corticosteroid therapy.  


Blanco R, Martínez-Taboada VM et al. Henoch-Schönlein purpura in adulthood and childhood: two different expressions of the same syndrome. Arthritis Rheum. 1997;40(5):859-864.

Szer IS. Henoch-Schönlein purpura. Curr Opin Rheumatol. Jan 1994; 6(1):25-31.

Henoch E. Lectures on children’s diseases. Second volume (translated from fourth edition). The New Sydenham Society,London. 1889:373–376.

Miller ML, Pachman LM. Henoch-Schonlein purpura. In: Kliegmen RM, Jenson HB, Behrman RE, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia: Saunders; 2011; p868-871.

Levy M, Broyer M, Arsan A, et al. Anaphylactoid purpura nephritis in childhood: natural history and immunopathology. Adv Nephrol Necker Hosp 1976; 6:183.

Bayram C, Demircin G, Erdo��an O, et al. Prevalence of MEFV gene mutations and their clinical correlations in Turkish children with Henoch-Schönlein purpura. Acta Paediatr 2011; 100:745.

Dillon MJ. Henoch-Schönlein purpura: recent advances. Clin Exp Rheumatol 2007; 25:S66.

Rigante D, Castellazzi L, Bosco A, Esposito S. Is there a crossroad between infections, genetics, and Henoch-Schönlein purpura?. Autoimmun Rev 2013; 12(10):1016-1021.

Reinauer S, Megahed M,et al Schönlein-Henoch purpura associated with gastric Helicobacter pylori infection. J Am Acad Dermatol 1995; 33: 876–879.

Kim C J, Woo Y J,et al, Henoch-Schonlein purpura nephritis associated with Epstein-Barr virus infection in twins. Pediatr Nephrol 2004; 19:247–248.

Aktas B, Topcuoglu P,et al, Severe henoch-schonlein purpura induced by cytarabine. Ann Pharmacother 2009; 4:792-793.

Lau K, Suzuki H, Novak J & Wyatt R, Pathogenesis of Henoch-Schönlein purpura nephritis. Pediatr Nephrol 2010; 25: 19–26.

Saulsbury F, Henoch-Schönlein purpura in children: report of 100 patients and review of the literature. Medicine (Baltimore) 1999; 78(6): 395–409

Calvino M, Llorca J,et al Henoch-Schönlein purpura in children from Northwestern Spain: a 20-year epidemiologic and clinical study. Medicine (Baltimore) 2001; 80: 279–290.

Saulsbury F, Alterations in the O-linked glycosylation of IgA1 in children with Henoch-Schonlein purpura. J Rheumatol 1997; 24: 2246–2249.

Kraft DM, Mckee D, Scott C. "Henoch-Schönlein purpura: a review".American Family Physician 1998; 58 (2): 405–408, 411.

Simon Steddon,Neil Ashman,Alisain Chesser et al,kidney in systemic diseases,chapter 8,Handbook of nephrology and hypertention,Oxford,2nd edition,2014;650-651.

Chamberlain RS, Greenberg LW. Scrotal involvement in Henoch-Schönlein purpura: a case report and review of the literature. Pediatr Emerg Care 1992; 8:213.

Lind J, Mackay A & Withers S Henoch-Schönlein purpura and priapism. J Paediatr Child Health 2002; 38: 526–527.

Sandell J, Ramanan R & Shah D, Penile involvement in Henoch-Schonlein purpura. Indian J Pediatr 2002; 69: 529–530.

Garzoni L, Vanoni F,et al ,Nervous system dysfunction in Henoch-Schönlein syndrome: systematic review of the literature. Rheumatology (Oxford) 2009; 48: 1524–1529.

Wright W K, Krous H F, Griswold W R,et al. Pulmonary vasculitis with hemorrhage in anaphylactoid purpura. Pediatr Pulmonol 1994; 17: 269–271.

Trapani S, Micheli A, Grisolia F, et al. Henoch Schonlein purpura in childhood: epidemiological and clinical analysis of 150 cases over a 5-year period and review of literature. Semin Arthritis Rheum 2005; 35(3):143-153.

Rabei M. EL-Dubooni, A clinical Study Of Henoch – Schonlein Purpura In Mosul With follow up of renal involved cases Tikrit Medical Journal 2006; 12(1):85-88.

Amer A. Lardhi, Henoch-Schonlein purpura in children from the eastern province of Saudi Arabia, Saudi Med J 2012; Vol. 33 (9): 973-978

Trapani S, Micheli A, Grisolia F, et al. Henoch Schonlein purpura in childhood: epidemiological and clinical analysis of 150 cases over a 5-year period and review of literature. Semin Arthritis Rheum 2005; 35(3):143-153.

Anıl M, Aksu N, Kara OD et al. Henoch Schönlein purpura in children from Western Turkey: A retrospective analysis of 430 cases. Turk J Pediatr 2009; 51(5): 429-436.

İnal A, Yılmaz M, Kendirli SG et al. The clinical characteristics of children with Henoch Schönlein purpura. Erciyes Medical Journal 2009; 31(2): 153-161.

Aslan Yılmaz, Mehmet Baha Aytaç, Zelal Ekinci, Retrospective assessment of children with Henoch-Schonlein Purpura in and around Kocaeli Province and comparison with literature, Erciyes Med J 2014 36(2): 62-67.

Jauhola O, Ronkainen J, Koskimies O et al. Clinical course of extrarenal symptoms in Henoch Schönlein purpura: a 6-month prospective study. Arch Dis Child 2010; 95(11): 871-876.

Narchi H. Risk of long renal impairment and duration of follow-up recommended for Henoch-Schonlein purpura with normal or minimal urinary findings. A systematic review.Arch Dis Child 2005; 90: 916–920.

Peru H, Soylemezoglu O, Bakkaloglu SA et al. Henoch Schonlein purpura in childhood: clinical analysis of 254 cases over a 3-year period. Clin Rheumatol 2008; 27(9): 1087-1092.