Atypical Henoch-Schonlein purpura? Consider polyarteritis nodosa!

We describe the case of a previously healthy 12-year-old boy admitted to a tertiary paediatric centre with the clinical diagnosis of Henoch-Schonlein purpura (HSP). Symptoms on admission included a generalised rash, colicky abdominal pain, hypertension, proteinuria and fresh rectal bleeding. Abdominal pain and distension worsened and serial ultrasounds suggested bowel ischaemia.

A twist in the tale.

A 4-year-old girl presented with retching and abdominal colic and was initially diagnosed with gastroenteritis. However, progressive pain and epigastric distension led to a surgical review and she was discovered on CT scanning to have a gastric volvulus. She required urgent laparotomy to decompress the stomach and repair a perforation on the lesser curvature.