Derm Cases · Dermatology / Paediatrics / Nephrology
OSCE — childhood palpable purpura with abdominal pain: IgA vasculitis
An 8-minute OSCE station on diagnosing IgA vasculitis (Henoch–Schönlein purpura), excluding meningococcal sepsis, assessing GI and renal complications including intussusception risk, and planning supportive care with structured renal follow-up.
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Study tools
Target exams
NEET-PGINICETUSMLEPLABMRCP
Prompt
An 8-minute OSCE station on diagnosing IgA vasculitis (Henoch–Schönlein purpura), excluding meningococcal sepsis, assessing GI and renal complications including intussusception risk, and planning supportive care with structured renal follow-up.
Brief (to candidate)
A 7-year-old develops lower-limb and buttock palpable purpura after a mild URI. He has intermittent colicky abdominal pain and a swollen painful ankle. Platelet count is normal. Temperature 37.4°C, non-toxic. You have 8 minutes to diagnose IgA vasculitis, exclude dangerous differentials, assess organ involvement, and plan disposition with renal surveillance.
[1]Candidate instructions
- State the classic tetrad and diagnostic approach.
- Exclude meningococcaemia / purpura fulminans / thrombocytopenia.
- Assess GI (intussusception) and renal complications.
- Describe when biopsy/DIF is needed.
- Outline supportive care and renal follow-up duration.
Examiner checklist (mark each domain / 10)
| Domain | Key actions expected |
|---|---|
| Recognition | IgA vasculitis (HSP): palpable purpura (legs/buttocks) + normal platelets ± arthritis, colicky abdominal pain/GI bleed, haematuria/proteinuria — IgA1 immune-complex LCV[1][2] |
| Sepsis exclusion | Toxic appearance, fever, rapidly progressive purpura → meningococcaemia / purpura fulminans / DIC first — do not label HSP until safe |
| GI risk | Severe pain, bilious vomiting, bloody stool, distension → urgent imaging for intussusception or bowel ischaemia |
| Renal | BP, urine dipstick/microscopy, creatinine; nephritis may be delayed — structured follow-up (commonly months) even if initial urine normal; escalate nephrology for hypertension, rising creatinine, heavy proteinuria, nephritic/nephrotic features[3] |
| Confirmation | Typical non-toxic child often clinical diagnosis; uncertain/adult/atypical → skin biopsy LCV with IgA-dominant DIF |
| Management | Supportive care, analgesia, hydration; most self-limited; steroids for selected severe pain/orchitis/severe oedema (not proven to prevent nephritis); immunosuppressants for severe nephritis per nephrology protocols[5] |
| Safety-net | Return if severe pain, blood in stool/urine, reduced urine output, headache/visual change (hypertension), lethargy |
Model key actions
- Diagnose IgA vasculitis from purpura + normal platelets ± joint/GI/renal features.[1][5]
- Exclude life-threatening purpura differentials first.
- Screen and follow kidneys; image for intussusception if severe abdominal pain.[3]
Common errors
- Discharging without urine and BP check.
- Missing intussusception risk.
- Attributing toxic purpura to HSP without sepsis work-up.
- Assuming one normal urine rules out later nephritis.
- Overusing steroids assuming they prevent renal disease.
References4ShowHide
- [1]Parums DV. A Review of IgA Vasculitis (Henoch-Schönlein Purpura) Past, Present, and Future. Medical science monitor, 2024.PMID 38281080
- [2]Pillebout E, Sunderkötter C. IgA vasculitis. Seminars in immunopathology, 2021.PMID 34170395
- [3]Vivarelli M, Samuel S, Coppo R, et al. IPNA clinical practice recommendations for the diagnosis and management of children with IgA nephropathy and IgA vasculitis nephritis. Pediatric nephrology, 2025.PMID 39331079
- [5]Reamy BV, Servey JT, Williams PM. Henoch-Schönlein Purpura (IgA Vasculitis): Rapid Evidence Review. American Family Physician, 2020.PMID 32803924