過敏性紫斑症伴隨陰囊侵犯：病例報告及文獻回顧

楊鎧伍¹、李亞哲¹

嘉義基督教醫院 外科部 泌尿科¹

Henoch-Schönlein Purpura with scrotal involvement: A case report and review of the literature

Kai-Wu Yang¹，Ya-Che Lee¹

Divisions of Urology, Department of Surgery, Chia-Yi Christian Hospital¹

Introduction: 

   Henoch-Schönlein purpura (HSP), also known as anaphylactoid purpura, is a form of non-thrombocytopenic purpura and represents the most common systemic vasculitis of unknown origin in children. It often occurs following upper respiratory infections and is typically characterized by purpura, joint pain, and abdominal discomfort. However, genital involvement or the occurrence of scrotal edema is rare. We report an unusual case of a 4-year-old boy who initially presented with acute scrotal and penile swelling and was subsequently diagnosed with HSP based on his clinical history and ultrasound features.

Case presentation: 

    A 4-year-old boy presented with progressive purpura on his legs, feet, hands, scrotum and penis, along with joint and abdominal pain. He had a recent upper respiratory infection but denied fever, hematuria, or penile tenderness. Examination showed edema, petechiae, and pruritic purpura on the limbs, predominantly on the lower extremities, with erythema and swelling on the dorsal penis and scrotum. Laboratory results indicated normal white blood cell count and normal coagulation times but an elevated CRP level (1.285 mg/dL). Tests for serum C3, C4, ANA, anti-ds-DNA antibodies, and connective tissue disease screen were unremarkable. Color Doppler ultrasound showed bilateral scrotal swelling and subcutaneous edema, with normal testicular echogenicity and vascularity. Diagnosed with HSP, he was treated with Prednisolone 10mg twice daily and closely monitored. Three days later, his symptoms improved with resolution of penile swelling and scrotal purpura. The patient recovered well and was discharged home on day4.

Discussion:

   Henoch-Schönlein purpura (HSP) is the most common form of systemic vasculitis in children, characterized by the deposition of immune complexes containing IgA antibodies, though its precise cause remains unknown. Classic symptoms include purpura, arthritis, and abdominal pain, with rare complications such as scrotal involvement, which can sometimes be misdiagnosed as testicular torsion. Ultrasound, especially with color Doppler, is critical in identifying scrotal involvement in HSP and distinguishing it from other conditions. Bilateral involvement is typical, with ultrasonographic findings showing significant edema of the scrotal skin and contents, while testicular vascular flow remains intact. These imaging features support accurate diagnosis and help prevent unnecessary surgical exploration. Treatment with corticosteroids has shown effectiveness in managing this condition.

Conclusion: 

        Accurate diagnosis of HSP is essential, requiring early recognition of purpura and associated symptoms, along with imaging studies, to avoid unnecessary interventions. Once diagnosed, HSP should be managed conservatively with a short course of steroid therapy rather than surgical intervention.