DIFFERENTIAL DIAGNOSIS OF HEMORRHAGIC VASCULITIS WITH INFECTIOUS EXANTHEMS IN A CHILD: A CLINICAL CASE

Abstract

Introduction. Hemorrhagic vasculitis (IgA vasculitis or Henoch–Schönlein purpura) in children remains one of the most pressing issues in modern pediatrics and pediatric infectious diseases. The disease is characterized by systemic involvement of small vessels, an immune complex-mediated pathogenesis, and significant clinical variability, which considerably complicates timely diagnosis. Differential diagnosis between IgA vasculitis and infectious exanthems, which are common in children and may mimic the course of vasculitis, requires special attention.

Aim. To determine the key features of the differential diagnosis of IgA vasculitis and infectious diseases presenting with an exanthem in children, based on the analysis of a clinical case and current literature data.

Materials and methods. This article presents a clinical case of hemorrhagic vasculitis in an adolescent, initially considered an acute infectious disease with an exanthem. The course of the illness and rash characteristics are described in detail, which subsequently allowed for differential diagnosis and confirmation of systemic vasculitis. Special emphasis is placed on the importance of laboratory and instrumental examinations, particularly general indicators of inflammatory activity. The role of immunological factors, including immunoglobulin A, in small vessel involvement is discussed. A review of current literature is provided concerning the incidence of Henoch–Schönlein purpura in childhood, pathogenetic features, and risk factors. The role of immunological mechanisms – particularly the deposition of immunoglobulin A immune complexes in vessel walls, leading to complement activation, endothelial damage, and formation of the characteristic clinical syndrome – is highlighted. Triggering factors are also considered, with infectious agents playing a leading role. The role of basic therapy and the use of glucocorticosteroids is highlighted.

Results. An integrated analysis of the presented clinical case and the available literature data indicates that IgA vasculitis is a multifactorial disease in which infectious agents play a major role and requires careful clinical monitoring and thorough differential diagnosis with infectious exanthems.

Conclusions. Timely establishment of the correct diagnosis and the application of modern therapeutic strategies improve the prognosis and reduce the risk of complications. The analysis of results highlights the importance of interdisciplinary collaboration and a comprehensive approach in managing children with exanthematous diseases to optimize the diagnosis and treatment of IgA vasculitis.