Epidural Anesthesia in a Parturient with history of Henoch-Schonlein Purpura

Henoch-Schonlein purpura (HSP) is a systemic immunoglobulin A vasculitis that is relatively common in the pediatric population. HSP usually follows an upper respiratory tract infection and causes the “classic triad” of... [ view full abstract ]

Henoch-Schonlein purpura (HSP) is a systemic immunoglobulin A vasculitis that is relatively common in the pediatric population. HSP usually follows an upper respiratory tract infection and causes the “classic triad” of palpable purpura, arthritis, and abdominal pain. Additionally 40-50% of affected patients develop renal disease.¹ However, prognosis is typically favorable with less than 2% of patients suffering long term morbidity.² HSP is far less frequently described in adults. In fact, greater than 90% of HSP cases occur in children under ten years of age.¹ Its description in pregnancy is very rare. Under 25 cases have been reported.³ Of most concern, catastrophic hemorrhages have been described in the pediatric literature and HSP can be associated with Factor XIII deficiency. ^4,5,6 We present the case of an uncomplicated epidural placement and delivery in a 27-year-old pregnant female with a diagnosis of Henoch-Schonlein purpura but no active symptoms.