Case Report Central Nervous System Involvement in Henoch-Schonlein Purpura in Children and Adolescents Iliyana H. Pacheva, 1 Ivan S. Ivanov, 1 Krastina Stefanova, 1 Elena Chepisheva, 2 Lyubov Chochkova, 1 Dafina Grozeva, 1 Angelina Stoyanova, 1 Stojan Milenkov, 1 Penka Stefanova, 2 and Anna Petrova 3 1 Department of Pediatrics and Medical Genetics, Medical University-Plovdiv, Plovdiv, Bulgaria 2 Department of Pediatric Surgery, “St. George” University Hospital, Plovdiv, Bulgaria 3 Department of Imaging Diagnosis, “St. George” University Hospital, Medical University-Plovdiv, Plovdiv, Bulgaria Correspondence should be addressed to Iliyana H. Pacheva; inapatcheva@hotmail.com Received 8 July 2016; Revised 5 November 2016; Accepted 21 December 2016; Published 21 February 2017 Academic Editor: Abraham Gedalia Copyright © 2017 Iliyana H. Pacheva et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Central nervous system (CNS) involvement in Henoch-Schonlein purpura (HSP) is rare but poses diagnostic difculties. Te aim of the study was to establish the frequency of CNS involvement in HSP, to analyze its clinical characteristics and do a literature review. Medical fles of patients with HSP admitted at the Department of Pediatrics, Plovdiv, were studied retrospectively for a fve-year period (2009–2013). Diagnosis was based on the American College of Rheumatology criteria. Out of 112 children with HSP 1 case (0.9%) had CNS involvement presenting as Posterior Reversible Encephalopathy Syndrome (PRES), which may be a result of CNS vasculitis or arterial hypertension. It was an 8-year-old girl with atypical HSP which started with abdominal pain requiring surgery. On the third day afer the operation a transient macular rash and arterial hypertension appeared, followed by visual disturbances, hemiconvulsive epileptic seizures, postictal hemiparesis, and confusion. Head CT showed occipital hypodense lesions and MRT-T2 hyperintense lesion in the lef occipital lobe. Te patient experienced a second similar episode afer 2 weeks when palpable purpura had also appeared. Neurological symptoms and MRI resolved completely. HSP can be an etiological factor for PRES in childhood. Although PRES is a rare complication of HSP, clinicians must be aware of it and avoid diagnostic and therapeutic delays. 1. Introduction Henoch-Schonlein purpura (HSP) is a systemic vasculitis involving the small vessels. It occurs mainly in children; over 75% of patients are under 10 years of age [1]. Its inci- dence is 10–20 per 100,000 children [2–5]. Most com- monly afected are the skin, joints, gastrointestinal tract, and kidneys. CNS involvement in HSP is rare (0.65–8%) but poses diagnostic difculties and sometimes has long-term neurological sequelae [3, 6, 7]. Neurologic manifestations of HSP were frst described by Osler [8] in 1914 as transitory hemiparesis and decreased level of consciousness as a result from either oedema or brain hemorrhage. Tere are few case reports about the neurological manifestations of HSP (head- ache, seizures, hemiparesis, aphasia, cortical blindness, and impaired consciousness) [9–18] and even fewer studies [19, 20]. Many of them are written in the past century, when MRI with new sequences was not readily available. Moreover histologic confrmation of CNS involvement in HSP occurred casuistically [21, 22]. Tat is why the pathogenic mechanisms of CNS involvement in reported cases remain unclear. Con- temporary studies on the characteristics of CNS involvement in HSP with the use of modern imaging methods are needed to extend our knowledge of this category. 2. Aim Te aim is to establish the frequency of CNS involvement in children with HSP and to analyze its clinical characteristics and do a literature review. Hindawi Case Reports in Pediatrics Volume 2017, Article ID 5483543, 6 pages https://doi.org/10.1155/2017/5483543