my poor baby

To bring you up to speed if you don't know what's been going on, Nick has been pretty sick. He threw up several times on Saturday. He seemed much better on Sunday, but on Sunday night, he threw up in bed, with blood in the vomit. He also had a swollen eyelid and a rash on his face. We took him to the ER, and the doc there didn't really know what was wrong. He gave Nick Benadryl and Prednisone (thinking maybe allergic reaction) and an antibiotic cream for the rash (thinking maybe impetigo). While he was in the ER, Nick's "rash" spread rapidly, covering his forehead, between his eyes, and his nose, with some on his cheeks and chin. I felt really uneasy about his vague "diagnosis", and hated giving him the meds, not really knowing if he needed them or what was really wrong.

Yesterday, he had a follow-up appointment with a pediatrician (loved her!), and her best guess is that Nick has Henoch-Schoenlein purpura. This is pretty rare, and is a type of vasculitis (an inflammation of the blood vessels) thought to be caused by a faulty response of the immune system that can be triggered by any number of things - the trigger is often unknown. In Nick's case, it's possible that what he had on Saturday was just a stomach bug, and that triggered the later episode. Or, maybe the vomiting Saturday was part of the HSP. We just don't know. Anyway, the immune system ostensibly freaks out and causes small blood vessels in the skin to bleed, causing the purpura on the skin - Nick's "rash." The one thing about his case that is somewhat odd is that his purpura are on his face. Normally, they present on the lower body, but the doc said that facial presentation isn't unheard of. It can also cause bleeding of small vessels in the GI tract and the kidneys - this explains his bloody vomit; he obviously had a "bleed" in his stomach.

His case seems relatively mild; the doc is not 100% sure that's what it is, but she's pretty positive. It's the only thing that explains all of his symptoms, it's most common in children, and it's twice as common in boys as in girls. It's somewhat scary, because if bleeding occurs in the kidneys, it can cause kidney damage, and in rare cases, lead to kidney failure. After his appointment, Nick had to have blood drawn (That was a complete nightmare - he totally freaked out!) and have a urinalysis done. Luckily, these tests were all normal. They have to be repeated in 3 months and again in 6 months to make sure he's OK, because the kidney damage can appear later. But given the relative mildness of his case and the fact that these tests were fine, the doctor is quite confident that his kidneys won't be affected.

Apparently, this can last for up to 6 weeks, and it's possible that more purpura will appear on Nick's body. We also have to keep a close eye on his urine and stool for signs of blood. I have also learned that in the future, if he gets sick or his immune system gets "triggered" some other way, he could suffer a recurrence of HSP. I really hope that doesn't happen!

He's doing pretty well today. He's still tired and not 100%, but his purpura seem to be improving, and he has no other symptoms. So, he's back at school, and the nurse is keeping an eye on him.

If you're interested in reading more about this, here's a really good link:
http://www.mayoclinic.com/health/henoch-schonlein-purpura/DS00838