A 4-year-old boy with a 3-day history of fever, abdominal pain, and limp. O/E, there was left ankle swelling and tenderness along with a palpable rash shown in the image extending from the soles to the gluteal region. What is the most likely diagnosis?
Henoch schonlein purpura
Idiopathic thrombocytopenic purpura
Ans. B. Henoch schonlein purpura
Explanation: An acute onset palpable purpura in the dependent regions like lower limbs and gluteal regions is very characteristic of HSP. It is usually seen in children between 2-10 years of age. Often associated with arthritis, abdominal pain, and elevated ESR and CRP with occasional renal involvement.
Meningococcemia can also present with acute onset purpura, but associated arthritis and a relatively stable child make HSP more likely.
ITP and scrub typhus do not usually present with palpable purpura and arthritis.