Damage to legs from Henoch-Schonlein purpura? Stumped the doctors

Posted by jsimmons74 @jsimmons74, Apr 18, 2020

My son, 13 at the time, was diagnosed with HSP vasculitis February of 2018. Took several days to diagnose because he did not present with purpura rash on legs. He was in the hospital for 14 days. After 9 days of uncontrolled pain (including nerve blocks, morphine and hydrocodone) he was transferred to Vanderbilt in Nashville and was treated with Toradol, released 3 days later. Then treated with steroids for 4 months. 60 mg for a month, then 40, then 20, then 10. He seemed to recover. We then moved to Chicago in June 2018. July of 2018 he would complain when standing that his legs itched. Went to see Rheumatologist who said if it got worse to a vein dr. Legs only seemed to itch when standing still so my son did not want to see a dr. August 2019 the itching of the lower legs has started to get worse when standing. His legs turn bright red, but subside when he moves or sits down with legs up. By January 2020 his legs have become extremely painful when standing still for just a few minutes. PC doctor tried to get us into a Vein Doctor, but no one would see him because he was "pediatric". He is now 15 and over 6 feet tall. I continued to call around to all kinds of doctors trying to find SOMEONE to see him as his symptoms got worse. Finally got an Interventional radiologist at Lurie Children's Hospital to see him. He was able to watch my son's legs turn bright red between his ankles and knees as he stood still for the ultra sound. He said the ultrasound appeared normal, except for slightly narrow veins, and that he had never seen anything exactly like my son's issues. He referred us to a Vein doctor at Northwestern for more tests speculating the HSP may have done damage to the valves in the veins. The doctor at Northwestern did a more detailed ultrasound of the leg "simulating" standing by using cuffs around his ankles. The test did not produce the pain or reaction that normally happens in his legs while standing. The vein doctor also said he had also not seen anything quite like this, but the valves seem to be working normally. He asked my son if compression socks helped. My son said "no" and the doctor said that further confirmed that it most likely was not a valve issue. We were referred us back to a rheumatologist at Lurie Children's Hospital. His symptoms have steadily gotten worse. Started out as just itching, then a little bit red, then purple legs between ankles and knees. Now it has travelled into his feet and just above his knees and has been more and more painful. His legs turn crazy colors or red and purple and the pain has increased from itching to tingling to very painful now. The pain will subside if he gets up and moves around or sits down with his feet up in a recliner. It used to only happen when he stood still, now it happens while he is stilling down playing Tuba. He also complains of lack of breath when plays now. He sometimes gets really bad leg cramps. We are still waiting for an appointment because Covid19 has now happened we do not know when we will actually get him in. I have several pictures of his legs and didn't know if there was a way to post those. I have read all the different vasculitis and none of them seem to fit. It is getting to a point where it bothers him multiple times daily now. He is getting angry and frustrated as it gets worse. As a mother I worry about long term issues and know how much pain he was in the first time and do NOT every want to see him there again. Any ideas from anyone? He loves marching band and really wants to try out for DCI, but that requires that he be able to stand still and also be extremely active. At this time he can do neither.

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@jsimmons74

Thank you for the information. All of his tests so far have been related to the valves in the veins, but now that they have ruled that out maybe the will move on to other testing once we get to see the Rheumatologist. He handles it pretty well most of the time because the pain subsides when he lays down. It doesn’t hurt when he moves so that is a blessing. He is able to walk the dog for some exercise and mow the yard. When it does flair up he gets so angry and frustrated. Now that it bothers him when he is practicing tuba he gets very angry bc it is the one thing he loves doing. Holding out they do not cancel our appt at the end of the month, but I am going to call today and make sure bc it has definitely gotten worse.

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@jsimmons74 Hello, I’m wondering how your son is doing. Have you been able to talk with anyone yet?

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TY for checking. He’s managing. Has good days and bad days. He has an appt with the rheumatologist on Wednesday am. I really hope we leave with answers bc after 5 appoints and no answers I’m frustrated!

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Well Rheumatologist says it isn’t vasculitis. So now we have stumped several doctors with no answers and I am starting to get pissed that no one can figure this out! How do I even begin to get into Mayo Clinic for a diagnostic appointment ?

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Hi @jsimmons74 If you would like to make an appointment at Mayo Clinic, please call one of our appointment offices. You can also request an appointment online. The contact information for Minnesota, Arizona and Florida can be found here: http://mayocl.in/1mtmR63 Coordinators will ask questions to help direct you to the best specialist for your son.

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@amandaa

Hi @jsimmons74 If you would like to make an appointment at Mayo Clinic, please call one of our appointment offices. You can also request an appointment online. The contact information for Minnesota, Arizona and Florida can be found here: http://mayocl.in/1mtmR63 Coordinators will ask questions to help direct you to the best specialist for your son.

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TY I will do that today. I really thought between northwestern and Lurie’s Children’s Hospital we would have gotten an answer. They all agree something is going on but no one knows what!

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@jsimmons74

TY I will do that today. I really thought between northwestern and Lurie’s Children’s Hospital we would have gotten an answer. They all agree something is going on but no one knows what!

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Hello @jsimmons74,

I just now noticed this discussion about your son. I want to applaud you for your persistence in helping him to find an answer to this difficult problem. You are such a good advocate for him!

I hope that your next appointment will bring you some answers. Will you post again?

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@hopeful33250

Hello @jsimmons74,

I just now noticed this discussion about your son. I want to applaud you for your persistence in helping him to find an answer to this difficult problem. You are such a good advocate for him!

I hope that your next appointment will bring you some answers. Will you post again?

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I will definitely post again, we are not done with this journey yet! So I know I will be back here looking for guidance. I have received some good guidance and links posting here!
Julene

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@jsimmons74

I will definitely post again, we are not done with this journey yet! So I know I will be back here looking for guidance. I have received some good guidance and links posting here!
Julene

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@jsimmons74
I'm so glad to hear that Connect has been helpful to you, Julene. I'm looking forward to hearing from you!

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@amandaa

Hi @jsimmons74 If you would like to make an appointment at Mayo Clinic, please call one of our appointment offices. You can also request an appointment online. The contact information for Minnesota, Arizona and Florida can be found here: http://mayocl.in/1mtmR63 Coordinators will ask questions to help direct you to the best specialist for your son.

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So they called and got his information, I just have to hope they take him on. I liked the first person I talked to, but the next person I don’t feel like I really got to explain how bad it was. I did let her know we have been to 5 dr between Lurie’s and Northwest with no answers. But she asked how much school he has missed (none) and if he is anxious and depressed (no). Hope that doesn’t hinder his ability to be seen. The rheumatologist we saw the other day thinks it could be “Mays-Thurner” syndrome where a vein may be in a funny position in his leg getting “kinked”. Hoping to hear back next week about a standing MRI. If not praying Mayo will take him on as a patient. I did email his PC to see if he would do a referral for Mayo hoping that would help. Ugh the waiting.

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Hello @jsimmons74,

I am hoping, as you are, that your son will be seen at Mayo. I am not familiar with May-Thurner Syndrome but I did find some information about it on Cleveland Clinic's website, https://my.clevelandclinic.org/health/diseases/17213-may-thurner-syndrome.

Other than elevating his legs when they are hurting, have any other remedies been found?

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