Intermittent Gastrointestinal Bleeding in a Child: Leech Infestation

Published by: Tehran University of Medical Sciences (http://ijp.tums.ac.ir) hepatitis A, between two to three months before the first manifestations of HSP. Serum sickness can be the first presentation of acute viral hepatitis (especially hepatitis B)[6,7]. Serum sickness and HSP can be very similar to each other (both of them present with skin rashes and arthritis, and GI involvement also is common in both) but serum sickness occurs in the antigen excess phase of acute hepatitis before the appearance of jaundice, while in all of the reported cases of HSP with HAV, the vasculitis started after resolution of hepatitis, also C3 is normal or increased in HSP while is decreased in serum sickness[8,9]. During HSP itself (without accompanying viral hepatitis) hepatomegaly is not an unusual finding and hepatitis with jaundice can be seen in severe cases of HSP, but serologic markers of viral hepatitis are negative in these unusual forms of HSP. Chronic viral hepatitis with HCV or HBV can be accompanied with vasculitis but these are not common problems in children and clinical course and serology makes them different from HSP after hepatitis A.