A 40 years female has palpable purpura with rash over buttocks and thighs, pain in abdomen and ahropathy. Likely diagnosis is?
**Core Concept:** Palpable purpura, rashes, abdominal pain, and arthralgia are clinical manifestations of a specific disease or condition. In this question, we are looking for the most likely diagnosis based on these symptoms.
**Why the Correct Answer is Right:** The correct answer is **D.** Henoch-Schönlein Purpura (HSP), also known as IgA vasculitis, is a childhood disease that primarily affects small blood vessels, particularly the capillaries, small arteries, and arterioles. The clinical picture consists of purpura (non-bleeding, non-thrombocytopenic purpura), abdominal pain, arthritis/arthralgia, and gastrointestinal symptoms such as vomiting and diarrhoea.
HSP is caused by deposition of IgA immune complexes within the vessel walls, leading to inflammation and damage. The rash is typically maculopapular, non-itchy, and often involves the lower extremities (buttocks and thighs). The abdominal symptoms result from the inflammation of the small intestine, causing ischemia and reperfusion injury. Arthralgia and arthritis are due to vasculitis involving the joints.
**Why Each Wrong Option is Incorrect:**
A. This answer is incorrect because HSP is not exclusively a disease of old age. It primarily affects children, although adolescence and young adults can also be affected.
B. The rash in HSP is typically non-itchy and maculopapular, not bullous.
C. Although abdominal pain is present in HSP, the other symptoms (arthralgia, arthritis, and gastrointestinal symptoms) are more characteristic of the disease.
E. This answer is incorrect because HSP is not limited to the buttocks and thighs. The rash can involve other parts of the body, but HSP is more likely to affect the lower extremities.
**Why the Correct Answer is Right:** Henoch-Schönlein Purpura (HSP) is a clinical entity characterized by small blood vessel vasculitis, which can lead to purpura, gastrointestinal symptoms, joint pain, and abdominal pain. This disease is predominantly seen in children, but can also affect adolescents and young adults. The rash in HSP is non-itchy, maculopapular and typically affects the lower extremities, such as the buttocks and thighs, which is more likely than the other options provided. The disease is caused by deposition of IgA immune complexes in small blood vessels, leading to inflammation and damage.
**Why Each Wrong Option is Incorrect:**
Option A is incorrect because HSP is not exclusive to old age. It affects children, adolescents, and young adults.
Option B is incorrect because HSP is characterized by non-itchy maculopapular rash, not bullous rashes like Option C.
Option D is incorrect because HSP is more likely to affect the lower extremities (buttocks and thighs), not the buttocks and upper extremities as mentioned in Option E.
**Clinical Pearl:** Henoch-Schönlein Purpura is a clinical entity that should be considered in