Table 1 A timeline of events for a 4.5-year-old boy with Henoch-Schönlein vasculitis
Time point | Event |
|---|---|
Two week prior to presentation | • Upper respiratory tract infection with a painful throat, no doctor was consulted |
Day 1 - Presentation | • Presentation to a local hospital with fever without clear focal symptoms • Treatment with amoxicillin-clavulanic acid for a suspected bacterial lymphadenopathy |
Day 4 | • Patient was referred to the university hospital because of possible Kawasaki disease |
Day 7 | • Treatment with intravenous immunoglobulins for possible incomplete Kawasaki disease |
Day 8 | • Treatment with intravenous immunoglobulins for possible incomplete Kawasaki disease • Migrating joint pains in his neck, arms, and legs • No signs of arthritis on physical examination |
Day 9 | • Started treatment with diclofenac |
Day 13 | • FDG-PET/CT: increased FDG uptake in multiple joints (polyarthritis) and multiple bilateral cervical lymph nodes |
Day 14 | • Ultrasound evaluation of his joints: no signs of arthritis |
Day 17 | • Clinical improvement with diclofenac treatment • Discharged without establishing a diagnosis |
Day 24 | • Evaluation at our outpatient clinic • Multiple purpura on his lower limbs and buttocks for 1 day • Skin biopsy: leukocytoclastic vasculitis with positive IgA depositions • Diagnosis was established: Henoch-Schönlein vasculitis • Treatment with diclofenac was continued |
Day 25 | • Presentation with bloody stools and abdominal pain • Ultrasound: no signs of invagination or thickened intestinal walls • Treatment with prednisolone was started, diclofenac was discontinued |
Day 35 | • Clinical improvement • Dosage of prednisolone was lowered |
Day 63 | • Relapse in joint pain and abdominal pain • Renal manifestation of Henoch-Schönlein vasculitis: hematuria and proteinuria • Dosage of prednisolone was increased |
Day 73 | • No clinical signs of Henoch-Schönlein vasculitis • Treatment with prednisolone was discontinued after gradually lowering the dosage |