Letter: Mycoplasmal pneumonia preceding Henoch-Schonlein purpura.

Mycoplasmal pneumonia preceding Henoch-Sch'onlein purpuraSir, Mycoplasmal pneumonia and Henoch-Schonlein purpura are well-defined clinical entities.We report a case in which the two conditions occurred in probable causal association.Case report An 8-year-old Caucasian boy presented with the history of a cough and a low grade fever for one week.This was followed by painful swelling of the right elbow and left ankle together with central abdominal pain associated with vomiting for one day.On the moming of admission, a nonirritating rash developed on the buttocks and lower limbs.He was a well-nourished boy with an evident, nonspasmodic cough and slight dyspnoea.There was no cyanosis.The blood pressure was normal and the axillary temperature was 37-5 'C.The typical Henoch-Schonlein maculopapular purpuric rash was noted on the buttocks and the flexor aspect of both lower limbs.No rash was evident on the trunk or the upper limbs.Crepitations were heard over the right middle lobe region.There were evident painful swellings of the right elbow and left knee joints.Other systems were normal.Hb 12-4 g/100 ml; WBC 9600/mm3; neutrophils 71%/, lymphocytes 24%, monocytes 5% (no atypical cells seen); platelets 240,000/mm', ESR 20 mm/hr.Cold agglutination titre, positive at 1 in 16 at 4 'C.Mycoplasma pneumoniae CFT, >1 in 2560.Chest x-ray showed a patch of pneumonia at the right hilar region radiating outwards along the course of the bronchovascular markings.Stools for occult blood, positive.The following were normal or negative.Urinalysis, blood urea and electrolytes, throat swabs, bleeding time, prothrombin time, KCT, blood culture, antinuclear factor by fluorescent dye test.