A Rare Cause of Macroscobic Hematuria: Nutcracker Syndrome

Nutcracker syndrome caused by compression of the left renal vein between the abdominal aorta and the superior mesenteric artery is a rare anatomo-pathological condition. The patients have symptoms such as hematuria, proteinuria, and left flank pain. In this paper, we report a 13-year-old boy who presented with macroscopic haematuria. Routine laboratory tests for the evaluation of hematuria were normal. Abdominal computed tomography revealed that the left renal vein was compressed between the aorta and the superior mesenteric artery. A diagnosis of nutcracker syndrome was established. If Nutcracker syndrome is considered in the differential diagnosis of haematuria, it is easily diagnosed by imaging techniques

Lumbar Swelling as the Unusual Presentation of Henoch-Schonlein Purpura in a Child

Background: Henoch-Schönlein Purpura (HSP) is a systemic hypersensitivity disease of unknown cause that is characterized by a purpuric rash and systemic manifestations, such as colicky abdominal pain, polyarthralgia, and acute glomerulonephritis. Common complications of HSP that lead to surgical intervention include intussusception, perforation, necrosis, and massive gastrointestinal bleeding. Unusual clinical manifestations of HSP may include edema of the scrotum and eyes. Lumbar swelling is rarely seen as a complication of HSP. Case Report: A four-year-old boy was admitted to our emergency room with a 7 day history of increasing abdominal pain. Within 48 hours of admission, erythematous macules and palpable purpuric lesions developed on the lower extremities. On the third day of hospitalization, sudden onset of severe back pain, swelling on the lumbar region and refusal to walk were seen. On the fifth day, lumbosacral edema and pain resolved but facial edema developed. He was diagnosed clinically with HSP. Conclusion: To the best of our knowledge, only a few cases of HSP with lumbar edema have been reported so far. If the first clinical symptoms of HSP are atypical, clinical progress can be atypical, too

An Unusual Association of Pyoderma Gangrenosum with Henoch-Schonlein Purpura in a Child

Henoch-Schonlein purpura (HSP) is a systemic vasculitis affecting small vessels. Pyoderma gangrenosum (PG) is an uncommon, non-infectious, neutrophilic dermatosis. A sixteen-year-old boy was admitted to our clinic with arthralgia, palpable purpuric rush and a wound on the left lower extremity. Dermatological examination revealed an ulcer 3x3 cm in diameter covered with necrotic material and surrounded by a bluish ring. The lesion was found to be clinically compatible with pyoderma gangrenosum. Histological examination of the biopsy material taken from the purpuric rush was compatible with leukocytoclastic vasculitis. Direct immunofluorescence showed IgA class antibody and C3 deposition within the dermal capillaries. These findings were suggestive of HSP. We report a case of HSP with PG like ulcer. To the best of our knowledge, only one adult case of HSP with PG has been reported so far