A 9-year-old boy was admitted with abdominal pain, vomitting and purpuric rashes predominantly on his buttocks, both arms and legs. Two weeks before he had been admitted with swelling of feet, vomitting, abdominal pain and purpuric rash to another hospital. He had been diagnosed with HSP and hopsitalized for 10 days. On physical examination, the body temperature was 38.5ºC and blood pressure 100/50 mmHg. Palpable purpuric rashes were observed predominantly over his buttocks, both arms and legs. The white blood cell count was 9900/mm3, hemoglobin 10.5 g/dL, erythro-cyte sedimentation rate 14 mm/h. Platelet count was normal. The kidney function tests were normal. Occult blood test in stool was positive (+4). Anti-nuclear antibody, anti DNA, IgA, complement C3, C4 and C-reactive protein levels were in normal limits. Urine, blood and throat cultures were negative. He was diagnosed with HSP. Prednisolone was started because of gastro-intestinal involvement. On the 4th day, exanthem was observed on his trunk. These included vesicles, macules and papules suggestive of Varicella zoster infection. Prednisolone therapy was discontinued. Varicella zoster antibody was studied in sera and the result was positive. Although his urinalysis was normal at first, on the 14th day mild proteinuria lasting eight days was observed. On the 29th day purpuric rashes faded and exanthems disappeared.

Our patient was diagnosed with varicella because of typical varicella lesions and IgM antibodies against varicella in sera. Most common infectious agents that trigger HSP are streptococcus, parvovirus, Epstein-Barr Virus, Yersinia, and adenovirus. But varicella zoster associated HSP is a rare condition that has been reported previously(1-5). HSP has been reported to occur both before and after the appearance of varicella rash(1-3).

Vasculitic process may be observed in incubation period of some viral infections. Viral antigens may induce immune complex production in sera in these infections. Vascu-litic process may be developed by varicella antigens induced immune complexes. Thus, varicella infection should also be considered as triggering agent for HSP.

Mukaddes Kalyoncu,
Ender Odemis,
Nilgun Yaris,
Aysenur Ökten,
Faculty of Medicine,
Department of Pediatrics,
Trabzon,
Turkey 61080
E-mail: [email protected]