MY HEALTH EXPERIENCE:From a rash of pink spots to Henoch-Schönlein Purpura, write JUSTIN AND MICHAEL COMISKEY
MICHAEL, my normally bouncy four-year-old son, had been a bit off form all day – nothing too serious, we thought, until a rash of bright pink spots appeared on his legs.
We did the “Tumbler Test” for meningitis – where you press a glass against the rash to see if it fades and, if you can still see the spots, the advice is to seek medical attention immediately. Michael’s spots were clearly visible. I looked at the missus. We gulped.
Two minutes later, Michael and I were in the car charging for Crumlin hospital. The traffic was light that Saturday at about 8pm but, even still, I broke red light after red light. Twenty minutes later we were at the emergency department. After showing the receptionist Michael’s rash, we were quickly seen by a triage nurse and, rather than return to the waiting room, we were moved to a priority queue to see a doctor. Over the next two minutes, Michael was examined by a number of doctors and nurses. They seemed concerned – while not trying to alarm us – and next thing we were whisked away and given a room. As the door closed behind us, I gulped again.
Michael was hooked up to monitors to check his blood pressure, had his (slight) temperature checked at regular intervals and samples of his blood and urine were sent to the hospital lab for analysis. But his rash – now in bright pink blotches – was spreading fast, virtually consuming his legs and moving up his torso and arms.
The registrar was “worried” about meningitis but didn’t want to diagnose just yet – not until the results from the lab were available in about an hour’s time. Michael, who is very chatty, spent that time asking the nurses questions about their equipment and telling them how to play with his train set. His father needed tranquillisers.
Finally, the results from the lab arrived. “There’s nothing to suggest meningitis,” the registrar said, “but we can’t explain the rash, temperature or Michael being off form. We need to keep him under observation.”
We went over Michael’s medical history again. Any allergies? None. Any illnesses? Nothing of note. Ever hospitalised? Never. Appetite? Substantial and healthy. Had he been in contact with anything unusual recently? No. The registrar was perplexed.
At about midnight, the bright pink of the early spots on Michael’s legs began to darken into a bruise-like colour. His joints started to swell and any movement became painful. But his blood pressure and temperature were normal.
When the registrar heard about the joints swelling, a light bulb seemed to go off in her head. She went to do some research and returned, with a satisfied look, half an hour later.
“I think he’s got HSP, but I’m not certain, so I’ll put him on steroids for two weeks and, if it breaks out again, come back to us straight away.”
HSP – Henoch–Schönlein Purpura – is a systemic vasculitis (inflammation of blood vessels) causing palpable purpura (small haemorrhages which are a ringer for the rash associated with meningitis), and joint and abdominal pain. It also affects other organs, particularly the kidneys, so there may be traces of blood and protein in urine.
It mainly affects children between the ages of two and 10, and causes irreversible kidney damage in about one in a hundred cases. Happily, HSP normally resolves within several weeks and requires no treatment apart from symptom control.
It was about 3am before we were released to go home and, reassured that the condition was not too serious and only required careful observation, we hit the road, but not before one of the nurses observed: “That was enough excitement for one night.”
The next two weeks passed as normal. Michael was his usual bouncy self – his teacher smiled a touch wearily when she heard that he was now on steroids – but as soon as the two-week period of medication passed, the HSP returned with a vengeance.
As his joints swelled, walking became a real problem for Michael. He couldn’t play football. He tired easily, wouldn’t eat, got occasional temperatures and the rash seemed to take over his legs and arms. It got so bad that by 3pm most days he couldn’t move without yelps of pain. After three days of this he started vomiting – his face turning yellow in the process.
We phoned Crumlin emergency department and they advised to bring him in again. Between bouts of vomiting the nurses and doctors repeated the same series of tests as before but, to err on the side of caution, they kept him in overnight so he could be seen by a consultant the following morning.
After a frightful night spent at my son’s bedside I was relieved that the consultant, Dr Zaid, confirmed the HSP diagnosis and warned us to monitor his urine for traces of blood, as this suggests the early stages of kidney damage.
He recommended bringing Michael back to hospital if blood was present in his urine and suggested fortnightly visits to the GP for three months to have Michael’s urine checked. In addition to the GP visits, we decided to buy a dipstick set, so we could check his urine more regularly.
For the following two weeks, the HSP continued unabated. Michael missed a lot of school but at least there was no sign of blood in his urine – that prospect filled us with dread. And then it started, first only a mild blood reading on the dipstick, which Crumlin advised was nothing to worry about, but this gradually worsened over the next few days until it reached the highest level.
Alarmed, I drove Michael to Crumlin hospital. The same blood and urine tests were performed again. Yes, there was blood present in his urine, but not in sufficient quantity to justify further intervention. Only when the blood turns the urine pink, apparently, would medical intervention be considered. It was, yet again, after 3am before we were released to go home.
After a battle, the hospital agreed to a follow-up appointment for Michael with Dr Zaid. Regular urine checks were advised but, as the blood levels had not increased in the interim, the advice was to sit tight and ride out the storm. HSP, we were told, tends to be intense at the start and then peters out. Yes, but when? We were told it could be a year or many months, nobody knows.
Gradually, some three months after it started, the HSP began to recede. Michael’s rashes became less intense and his joints stopped swelling. Soon he was back playing football, riding his bike and eating like a horse. Just before Christmas the HSP disappeared – and hasn’t been seen since. It was the best present I ever received.
