Theisen E, Lee DE, Pei S, Schauder DM, Chiu YE, Brandling-Bennett H, Curran ML, Klein-Gitelman M, Co DO, Arkin LM. Hypergammaglobulinemic purpura of Waldenström in children.
Pediatr Dermatol 2020;
37:467-475. [PMID:
32104943 DOI:
10.1111/pde.14120]
[Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND
Hypergammaglobulinemic purpura of Waldenström (HGPW), a rare cutaneous eruption characterized by the triad of recurrent episodes of lower extremity petechiae, symptoms of stinging and burning, and lower extremity edema, is poorly described in children. Some children have been reported to follow a benign course, while others are eventually diagnosed with fulminant rheumatologic disease.
OBJECTIVES
To determine the distinguishing features of HGPW including the spectrum of disease manifestations and clinical outcomes.
METHODS
This is a multicenter, retrospective case series of six children with HGPW combined with a literature review of 45 previously published pediatric cases.
RESULTS
Most children were eventually diagnosed with systemic disease (63%) or developed autoantibody accumulation suggestive of evolving disease (71%). The most common diagnoses were Sjogren's syndrome and systemic lupus erythematosus. The mean duration between onset of cutaneous eruption and diagnosis of systemic disease was 5.6 years, underscoring that HPGW patients often present with a rash that precedes the development of systemic symptoms.
CONCLUSIONS
Diagnosis of HGPW should prompt initial screening for rheumatologic disease with long-term rheumatology follow-up, as the majority of patients present with evolving manifestations of systemic disease.
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