American Board of Internal Medicine (ABIM) Certification Practice Exam

How should an adult with severe Henoch-Schönlein purpura be treated?

1. Only supportive care

2. Antibiotics therapy

3. Immunosuppressive therapy

4. Prednisone treatment

The correct answer is: Prednisone treatment

In the management of severe Henoch-Schönlein purpura (HSP), the use of prednisone treatment is typically indicated, especially when the condition is complicated by significant abdominal pain, gastrointestinal bleeding, or severe renal involvement. Prednisone is a corticosteroid that can help reduce inflammation and control the immune response, which is particularly important in cases where there is a high risk of complications. In mild cases of HSP, supportive care may be sufficient, involving hydration and pain management. However, when symptoms become severe, the introduction of prednisone can lead to a significant improvement in symptoms due to its anti-inflammatory properties. The decision to administer corticosteroids is also based on the observation that these medications may expedite recovery in patients with more severe presentations of the disease. Antibiotics and immunosuppressive therapy are generally not indicated for HSP, as the condition is not caused by a bacterial infection and doesn't typically respond to immunosuppressive agents. Supportive care alone would be inadequate in cases where severe symptoms are present and steroid treatment can mitigate potential complications, leading to better outcomes for the patient.