Henoch-Schonlein Purpura in A Child Complicated by Fatal Pulmonary Hemorrhage

We report an 11-year old, Saudi boy who was diagnosed as Henoch-Schonlein Purpura (HSP). During the course of his illness he suffered from severe HSP nephritis and had been managed by steroids and mycophenolate mofetil. Later on, he developed cough with low oxygen saturation, followed by severe pulmonary hemorrhage and deteriorating respiratory status for which he needed to be ventilated. Cyclophosphamide was added and peritoneal dialysis was started, but the boy died within few days due to respiratory failure secondary to massive pulmonary hemorrhage. Pulmonary hemorrhage is a rare yet, severe complication of HSP. Only 19 pediatric cases were reported in literature with 5 deaths including our case. Early recognition of this complication is important so as to start proper management. Cyclophosphamide with steroids are essential for treatment of such cases, especially when associated with renal impairment.