Arterial Hypertension without Renal Involvement in Pediatric Henoch–Schönlein Purpura: A Case Report

Abstract

Background: Henoch–Schönlein purpura (HSP), also known as IgA vasculitis, is the most common vasculitis in children, primarily affecting the skin, joints, gastrointestinal tract, and kidneys. Hypertension (HTN) usually occurs in cases with renal involvement, but it may rarely present without detectable renal lesions. Objective: This case report describes a pediatric case of Henoch–Schönlein purpura complicated by hypertension in the absence of renal involvement. Case Presentation and Discussion: We report the case of a 4years and 6 months-old child admitted for arthralgia, abdominal pain, and extensive purpura of the lower limbs. During hospitalization, she experienced worsening abdominal pain, and ultrasonography revealed a transient intussusception. Unexpectedly, significant arterial hypertension was detected. Renal investigations, including 24-hour proteinuria and renal Doppler ultrasound, were normal, ruling out overt nephropathy. The patient was treated with an angiotensin-converting enzyme (ACE) inhibitor, which was well tolerated and led to normalization of blood pressure. Some aspects remain unclear, such as the mild and delayed microalbuminuria, which may reflect subclinical glomerulopathy. These hypotheses could not be further documented in the absence of a renal biopsy. Conclusion: This case highlights that hypertension can occur in children with HSP even in the absence of renal involvement. Systematic blood pressure monitoring should be performed in all pediatric patients. Further studies are needed to elucidate the underlying pathophysiological mechanisms and to optimise therapeutic management.