(Disclaimer: This article is for general use only, and the information in the following content has been processed to protect patient privacy)
Abstract: An 18-year-old boy, usually healthy, came to the clinic with abdominal pain, excluding gastroenteritis, appendicitis, intestinal obstruction, gastrointestinal perforation and other acute abdominal diseases. The platelets returned to normal.
Basic information】Male, 18 years old
Disease Type】Abdominal allergic purpura
Hospital】The 988th Hospital of the PLA Joint Logistics and Security Forces
Date of consultation】August 2020
Treatment plan】Medication (vitamin C injection + injectable sodium methylprednisolone succinate + omeprazole enteric solution + glucose sodium chloride injection + vitamin B6 injection + methylprednisolone tablets + vitamin C tablets + chlorpheniramine maleate tablets)
[Treatment Period] Half a month of inpatient treatment, half a month after the outpatient review, follow-up 1 year
Effectiveness of treatment] Abdominal pain symptoms are relieved, bleeding spots on the extremities disappear, and examination results return to normal
I. Initial interview
An 18-year-old boy came to the hospital bending over his abdomen and covered with sweat. Detailed inquiry revealed that the patient began to have abdominal pain shortly after dinner yesterday, with paroxysmal colic, no nausea, vomiting or fever, thinking that the seaweed stew he had eaten was indigestible, and oral domperidone tablets and gastrointestinal tablets did not improve, and the abdominal pain worsened. The patient was examined quickly, showing a slightly tense abdomen with pressure pain, normal bowel sounds, no palpable mass and plate-like abdomen, while the patient was found to have dense bleeding spots on the extremities, partly fused into small purpura, no bleeding spots on the thorax and abdomen, further detailed questioning revealed that there had been abdominal pain from eating kelp before, it was relatively light, did not care, and then did not eat, this time ate more. Combined with the medical history, symptoms and signs, allergic purpura was considered. We arranged abdominal plain film, abdominal ultrasound, blood routine, urine routine and other tests to exclude acute abdominal disease. The examination results showed that the abdominal plain film, abdominal ultrasound and urine routine were normal, the blood routine indicated that the white blood cell and red blood cell were normal, and the platelet dropped significantly to 68×10^9/L. The patient was admitted to the hospital immediately according to abdominal allergic purpura.
II. Treatment history
The patient’s condition progressed rapidly, with abdominal pain, bleeding spots on the skin and rapid decrease of platelets in less than 24 hours, and was given a comprehensive treatment plan immediately after admission, including oral anti-allergic chlorpheniramine maleate tablets, vitamin C injection to improve vascular permeability, and the addition of glucocorticoid injection with sodium methylprednisolone succinate after discussion in the department and informed consent of the patient and family. At the same time, the patient was advised to take oral omeprazole enteric soluble tablets to protect the gastric mucosa and prevent gastrointestinal bleeding; the patient was instructed to temporarily eat a small amount of light liquid food, and glucose sodium chloride injection, vitamin C injection and vitamin B6 injection were used to enhance fluid replenishment to ensure extra-gastrointestinal nutrition, and vital signs and urinary and bowel protection were closely monitored.
III. Treatment effect
After 1 day of treatment, the patient’s abdominal pain was reduced and the bleeding spots on the skin of the extremities did not increase any more. The platelets rose to 193×10^9/L, and the injectable sodium methylprednisolone succinate was reduced to a small amount, and the patient was discharged with methylprednisolone tablets, vitamin C tablets and chlorpheniramine maleate tablets to consolidate the treatment. The results of routine blood tests and liver and kidney functions were normal and stable after half a month, and the patient was followed up for 1 year without any discomfort.
IV. Notes
The patient’s condition has improved significantly, and we are happy for him, but after discharge, we still need to consolidate treatment and do a good job of daily protection to prevent recurrence of the disease: 1.
1, combined with the patient’s past history of abdominal pain and the cause of this attack, consider that he is allergic to kelp and induced abdominal allergic purpura, avoid eating such food in the future.
2, if there is abdominal pain, abdominal distension, joint pain, skin bleeding spots and other manifestations to seek medical attention in a timely manner, so as not to delay the disease.
3, daily diet avoid spicy, cold food, avoid smoking and alcohol.
4, oral medication as instructed, methylprednisolone tablets are hormonal drugs, pay attention to oral and genital hygiene to prevent secondary infection.
V. Personal insight
The patient was admitted to the hospital in time, although there was a sharp decrease in platelets and bleeding spots on the skin, after timely treatment, no gastrointestinal bleeding was induced by the decline in platelets, and the condition gradually improved after treatment, and the platelets returned to normal levels, which can be said to be alarming without danger. Therefore, it is important to avoid contact with allergens to prevent this disease and to provide early diagnosis, treatment and care once it develops. Fortunately, the patient is suffering from abdominal type of allergic purpura, although the onset of the rampant, but the general prognosis is better, if the renal type of allergic purpura, a few people may turn into chronic kidney disease, the prognosis is worse.