1 - Serviço de Cirurgia Pediátrica do Hospital Central do Funchal
2 - Serviço de Cirurgia Pediátrica; Hospital de Dona Estefânia, CHULC, EPE
- Publicação – Images in Pediatrics, Portuguese Journal of Pediatrics, Vol. 52, No. 2 (2021):166-7; DOI: https://doi.org/10.25754/pjp.2021.21090
Resumo: A previously healthy 5-year-old boy was presented in emergency department with penile swelling and erythema that started three hours earlier. He denied penile trauma, fever, or urinary symptoms. Physical examination showed an edematous phallus with irreducible foreskin and a penile red purpuric lesion that spread to the scrotum. No purulent discharge from preputial orifice or purpuric rash in any other part of the body was seen. Laboratory data revealed normal white blood cell count, normal coagulation tests and slightly elevated C-reactive protein (12,5mg/L). The urinalysis was normal, without proteinuria or hematuria. The ultrasound showed a bilateral scrotal and penile soft tissue thickening, with normal size and vascularity of both testicles, but with linear hyperechogenic foci in the left testicle suggesting a small vessel vasculitis. The child was admitted for clinical surveillance and was treated with intravenous amoxicillin/clavulanate and oral prednisolone (1 mg/kg/day). After admission, a purpuric rash was identified in buttocks and thighs and the diagnosis of Henoch-Schönlein Purpura (HSP) was made. He was discharged on third day after clinical improvement. The patient remains under close follow-up without renal complications. HSP is an immune-mediated systemic vasculitis most common in childhood. The classic tetrad is palpable purpura, joint pain, gastrointestinal complaints, and renal involvement. Penile involvement of HSP is very rare and include thrombosis, priapism or purpuric lesions that may appear before or after the onset of the HSP. It may occur in isolation or in association with scrotal involvement. When penile involvement is the first manifestation of HSP, the etiological diagnosis may be difficult and misdiagnosed as balanoposthitis, paraphimosis or sexual abuse. The role of steroid therapy in penile HSP is still controversial. Its use can cause a rapid response in healing process and save the penis from the permanent sequel of an end-organ vasculitis.
Palavras-Chave: Child; Penile Diseases/etiology; Henoch-Schönlein Purpura