Atypical presentation of Henoch-Schoenlein purpura in two children

Henoch-Schoenlein purpura (HSP) is a common vasculitic disorder of childhood. Patients with this disorder typically present with palpable purpura or petechia associated with one or more of the following signs and symptoms: abdominal pain, arthritis/arthralgias, and nephritis. The diagnosis may be difficult to make, however, when a patient presents with isolated symptoms such as abdominal pain without the typical rash. A high index of suspicion must be maintained to diagnose HSP in this setting and to avoid unnecessary interventions. This report describes two unusual patients with the presenting complaint of abdominal pain who had delayed onset of the purpuric rash, making the diagnosis of HSP difficult.