Case report Bilateral brachial plexopathy complicating Henoch–Scho ¨nlein purpura Cahide Yılmaz a, * , Hu ¨seyin C ¸ aksen a ,S ¸u ¨kru ¨ Arslan b ,O ¨ mer Anlar c , Bu ¨lent Atas ¸ b , Ahmet Sami Gu ¨ven a , Dursun Odabas ¸ a a Department of Pediatric Neurology, Yu ¨zu ¨ncu ¨ Yıl University Faculty of Medicine, Van, Turkey b Department of Pediatric Nephrology, Yu ¨zu ¨ncu ¨ Yıl University Faculty of Medicine, Van, Turkey c Department of Neurology, Yu ¨zu ¨ncu ¨ Yıl University Faculty of Medicine, Van, Turkey Received 1 December 2004; received in revised form 14 September 2005; accepted 29 September 2005 Abstract An 11-year-old boy presented with convulsion, fever, rash, abdominal pain, swelling on the eyelids, elbow and wrists, oliguria and hematuria. Based on the abnormal findings the patient was diagnosed with Henoch-Scho ¨nlein purpura. On the 3rd day of admission, neurological examination showed ataxic gait, loss of deep tendon reflexes, and decreased (4/5) of muscle strength on all extremities. Additionally, bilateral loss of touch, pain and temperature sensation in a glove, from the elbows to distal region (on C5-T1 level) was diagnosed. Cerebrospinal fluid examination and cranial magnetic resonance imaging (MRI) were normal. The patient was discharged with oral prednisolone on the 7th day of admission. One week after discharging from the hospital, he was re-admitted with vertigo and seizures. He was in coma. MRI of cranial, cervical and cervical plexus were normal. Electromyography showed severe bilateral brachial plexopathy. Prednisolone and intravenous immunglobulin (IVIG) therapy were given without significant improvement. He was discharged from the hospital on the 17th day of admission. On the second month of follow-up, a second cure of IVIG was given because of no clinical improvement. Now, he is on the 4th month of follow-up, unfortunately, no improvement was noted on his muscle strength and sensorial abnormalities on the upper extremities. q 2006 Elsevier B.V. All rights reserved. Keywords: Brachial plexopathy; Child; Henoch-Scho ¨nlein purpura 1. Introduction Henoch–Scho ¨nlein purpura (HSP), the most common vasculitis seen in children, is an immunologically mediated systemic vasculitis of small vessels that commonly affects the skin, joints, gastrointestinal tract, and kidney [1,2]. In HSP, central nervous system complications have been reported in 1–8% of children and are secondary to hypertension, renal failure or vasculitis [2,3]. We report a case of HSP associated with bilateral brachial plexopathy because of unusual presentation. 2. Case report An 11-year-old boy was presented with convulsion, fever, rash, abdominal pain, swelling on the eyelids, elbow and wrists, oliguria and hematuria. Physical examination revealed a blood pressure of 120/100 mmHg, bilateral symmetric palpable purpura on the lower extremities, abdominal defense-tenderness, swelling on the right ankle joint and right testicular edema. The remainder physical findings were normal. Electroencephalography was normal. Computerized tomography (CT) of the brain was normal. Histopathological examination of skin revealed leukocyto- clastic vasculitis. The patient was hospitalized with the diagnosis of HSP; captopril and phenytoin were initiated. On the 3rd day of admission, neurological examination showed ataxic gait, loss of deep tendon reflexes, and decreased of muscle strength on all extremities. Muscle strength was 4/5 on Brain & Development 28 (2006) 326–328 www.elsevier.com/locate/braindev 0387-7604/$ - see front matter q 2006 Elsevier B.V. All rights reserved. doi:10.1016/j.braindev.2005.09.007 * Corresponding author. Address: I ˙ skele Cad, Gu ¨neri C ¸ ıkmazı, Ali Pas ¸a Mah, Tus ¸balılar Sitesi. A Blok. No: 6, Van, Turkey. Tel.: C90 432 217 61 28; fax: C90 432 215 04 79. E-mail address: cahideyilmaz@yyu.edu.tr (C. Yılmaz).