ABDOM1NAL PLTR PURA (Henoch) In the course of a rheumatic purpura abdominal manifestations, such as vomiting, intestinal hmmorrhages and colic may appear under certain circumstances. These are productive of a peculiar ymptom complex which llenoch observed in several cases in ISGS and described in 1874. Since then a number of these cases have been published. The course is generally as follows: Sometimes after macules and cedema have existed in various joints, certain dyspeptic complaints occur, the articular pains become more severe, and new blood extravasations. make their appearance. Vomiting is exceedingly obstinate and diffi cult to control, the vomited matter consisting of colorless or greenish mucus at first, and changing later to dark bloody masses. Attacks of violent colicky pains torment the patient to such an extent that he groans and cries out in his bed. The pains generally increase until a defecation has taken place, which is generally accompanied with con siderable tenesmus. The stools at first scant and hard, become diar rhoea], assuming a blackish, dark red or orange yellow color. Anorexia is complete. In consequence of the pains, vomiting and loss of blood, patients become rapidly debilitated and give the impression of being. seriously ill.
The objective signs may be multiform small and medium-sized petechite, oedema, painfulness and stiffness of the knee and ankle-joints, sometimes also of the elbow-joints. The articular regions are likewise, the seat of the densest macular eruptions. The abdomen is distended and usually highly sensitive to pressure in the region of the transverse. colon. There is fever, which however does not exceed 3S.5° C. (101° F.) as a rule. The buccal cavity remains free from hemorrhages; there are no cardiac changes.
Like all forms of purpura, the abdominal variety is particularly characterized by paroxysmal manifestations with intervals of days, weeks or even a year, which tend to protract the illness considerably. The attacks themselves gradually diminish in vehemence, or the relapses may concern only the blood spots or only the articular swelling. Aside from these fully developed cases there are others.
in which one or other of the symptoms is absent, for instance the articular swelling.
Henochis purpura, like all other forms of purpura, should not be treated as an affection sui generic, there being only a question of specific localization of the affection in the area of the intestinal tract. No ana tomical observations in children have been reported, but the assump tion of blood extravasation into the mucous membranes of the stomach and intestine will probably not be far wrong. It is an undecided point as to what makes the intestine so sensitive. In the case of a ten-year old boy observed by the author the habitual consumption of alcohol (son of a restaurant keeper) and marked errors of diet were held respon sible for the cause of the first attack and the following relapses.
The prognosis is always to be made with caution on account of the grave condition and the impending danger of nephritis.
This affection, which was likewise first described by Henoch, rep resents an exceedingly rare, but the gravest, modification of purpura simplex. While hemorrhages from mucous membranes are absent, ex tensive eechymoses develop with alarming rapidity. They appear bilat erally and rather symmetrically, discoloring entire extremities within a few hours, first bluish red, then blue and black-red, and causing a coarse blood infiltration of the cutis. There is often a formation of serosan guineous vesicles upon the skin, but never gangrene, nor is there any fetid odor. The course is alarmingly rapid and always fatal; within 12-24 hours from the formation of the first blood spot death supervenes; the longest period was four days. There are no complications, autopsy yielding a negative result with the exception of general ammnia. In a few cases there are reports of a history of preceding acute infectious diseases, in others however there was a total absence of etiological indications.