henoch - schonlein purpura is one of the most common types of vasculitis in children .
henoch - schonlein purpura ( hsp ) is one of the most common types of vasculitis in children .
it is a multisystem disorder that involves various joints and organs , and results from a leukocytoclastic vasculitis of small vessels .
the characteristic clinical manifestations include non - thrombocytopenic purpura , arthritis or arthralgia , abdominal pain , gastrointestinal hemorrhage and renal abnormalities .
although patients with hsp are in a pro - thrombotic state , thrombosis is a rare complication , with only eight previously reported cases of hsp - associated thrombosis in the literature .
however , thrombosis is a potentially life - threatening condition , and clinicians should have a high index of suspicion for high - risk patients
. here , we present a single case of hsp accompanied by a superior mesenteric vein ( smv ) thrombosis .
a 14-year - old boy with no significant past medical or family history was admitted to our hospital complaining of abdominal pain for the previous 14 days .
he had passed dark red and black stool for 7 days , and had an erythematous rash over the anterior aspect of the lower legs for 2 days with a day of bilateral ankle arthralgia .
on general examination , his vital signs were stable and he had a palpable purpuric rash that predominantly affected the anterior aspect of his lower legs [ figure 1 ] ; the bilateral ankles were swollen .
palpable purpuric rash on the legs the laboratory results were as follows : hemoglobin level : 14.5 g / dl ; leucocyte count : 25.27  10/l with 81% polymorphonuclear leukocytes ; lymphocyte count : 13% ; platelet count : 492/mm .
serum electrolytes , blood urea nitrogen and creatinine , liver function tests , urine analysis , erythrocyte sedimentation rate , antinuclear antibody and anticardiolipin antibody levels and the coagulation profile were all within their normal ranges .
an abdominal computed tomography ( ct ) scan showed thickening of the proximal small intestinal wall with a peritoneal effusion .
the mesenteric ct venography was reported as a suspected smv thrombosis with edema of the proximal intestinal wall [ figure 2 ] .
mesenteric ct venography revealed heterogeneous contrast within the superior mesenteric vein with a suspected filling defect within the lumen ( arrow ) .
a thickened and blurred intestinal wall ( arrowheads ) as a result of edema was observed within the affected segments according to the clinical manifestations , laboratory results and radiological findings , the patient was diagnosed with hsp and suspected smv thrombosis .
after 7 days , his abdominal pain resolved and a repeated abdominal ct scan revealed that the intestinal wall edema and peritoneal accumulation had improved . on the 10 day of hospitalization ,
follow - up ct venography revealed homogeneous contrast throughout the smv and no signs of venous thrombosis [ figure 3 ] .
the pat ient had no abdominal pain , no new rash and no swollen joints .
he was discharged from hospital on the 12 day of admission . during the 2-month follow - up period , he had no new complaints .
homogenous contrast was observed within the superior mesenteric vein ( arrow ) , and the intestinal wall was even and well - demarcated ( arrowheads )
venous and arterial thromboses are rare but potentially life - threatening complications in patients with hsp .
we conducted a review of the published literature and found eight other patients with hsp - associated thrombosis [ table 1 ] .
the outcomes were good and most patients had no episode of relapse . reported cases of hsp associated with thrombosis hyperactivation of the coagulation system is a common phenomenon along with the impaired activation of the fibrinolytic system in hsp .
after prompt treatment with anti - inflammatories and anticoagulation , the symptoms and signs of hsp improved in our case .
so the follow - up ct venography showed no signs of thrombosis in the smv .
the seventh reported case showed that a high level of plasma factor viii and homocysteine could be a risk factor for thrombosis .
higher levels of homocysteine , which could be induced by endothelial injury associated with vasculitis , can cause hypercoagulability in patients with hsp .
furthermore , levels of von willebrand factor ( vwf ) antigen , a marker of endothelial injury , are also elevated during the acute stage of hsp .
factor viii , homocysteine and vwf antigen could be important risk markers that indicate patients at a higher risk of thrombosis .
two other reported cases that showed hsp was associated with antiphospholipid syndrome ( apa ) , which can present with thrombosis .
antiphospholipid antibodies can produce a procoagulant state by affecting the function of phospholipid binding proteins that are involved in the coagulation cascade .
the combined effect of hsp and apa would cause a greater risk of arterial or venous thrombosis .
in one further case hsp - associated thrombosis occurred in the context of behet 's disease , another form of vasculitis .
it is likely that endothelial dysfunction combined with a hypercoagulable state could contribute to thrombosis .
thrombosis is comparatively rare in hsp patients , but physicians should pay close attention to patients at a higher risk of developing thrombosis as a consequence of its potentially life - threatening outcomes .
thrombosis is a rare complication , with only eight previously reported cases of hsp - associated thrombosis .
 henoch - schonlein purpura ( hsp ) is one of the most common types of vasculitis in children . 
 the characteristic clinical manifestations include non - thrombocytopenic purpura , arthritis or arthralgia , abdominal pain , gastrointestinal hemorrhage and renal abnormalities . 
 thrombosis has been reported as , a rare complication of hsp . 
 we present the case of a 14-year - old boy who was diagnosed with hsp and suspected superior mesenteric vein thrombosis . 
 we reviewed the relevant literature and found eight similar reported cases . 
 hsp is associated with thrombosis and hsp itself and some risk factors may result in thrombosis . 
 we suggest that physicians should monitor patients with hsp who are at a higher risk of developing thrombosis more closely . 
Introduction
Case Report
Discussion
Conclusion