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.