The Link - June 2025

IgA vasculitis (IgAV), formerly known as Henoch-Schonlein purpura, is the most common small vessel vasculitis in children. In fact, it is the single most common vasculitis that pediatricians feel comfortable diagnosing and managing. While no diagnostic criteria are used in the diagnosis of IgAV, most patients will have the classic purpuric rash, plus at least one other typical symptom such as arthralgia, abdominal pain, or renal involvement. In the acute phase, the best treatment is supportive care. However, providers should be aware of both the possible acute and long-term complications.

Children and adolescents are especially vulnerable to the mental health consequences of climate change, facing both immediate physiological stress and long-term psychological challenges. Recognizing and addressing these risks is essential for supporting healthy development and resilience in the next generation.

The mental health effects of climate change intersect with, and compound, other challenges, such as poverty, racism, housing insecurity and limited access to care. Physicians have a professional and ethical responsibility to recognize these risks, provide compassionate care, and help young patients process their fears and emotions in a safe space. By doing so, they can foster resilience, offer hope, and connect families with the resources and support they need.

The advances in pediatric health care over the last two decades have been remarkable, from advances in critical care to the development of new clinical services and board certifications in Pediatric Hospital Medicine and Hospice & Palliative Medicine. Children and families are able to look with hope for speedier diagnoses (think genome and exome sequencing) and personalized care that is accessible across care environments in the hospital, at home, or through subspecialty clinics.

A 12-year-old boy with a history of vitiligo presented to dermatology clinic for evaluation of a rash.

Mother reported that the rash first developed three to four years ago. It started on his neck and eventually spread to his chest, abdomen, back and proximal arms. It has never been itchy or painful or has bled. Mother and patient note that the rash has waxed and waned since onset but never fully resolves. Mother has tried treating the rash with an over-the-counter eczema lotion, without improvement. They have never tried any prescription treatments for the rash. The patient is otherwise feeling well without recent fevers, weight loss, joint pains or fatigue. He is not currently taking any medications. No one else at home or in the family has a similar rash. A KOH preparation was performed on a sample of scale scraped from the rash. An image of the microscopy findings and clinical images of the patient’s rash are shown below.  

Summertime brings a change in chief complaints and reasons for sick visits. We see more injuries, rashes and insect bites. This is a great time to review our approach to tick bites and tickborne illnesses, which increase in prevalence from April to September.¹ What should raise our suspicions for a tickborne illness? How should we evaluate and treat these patients? The Department of Evidence Based Practice at Children’s Mercy recently created a clinical pathway to help practitioners when there is a suspicion for certain tickborne illnesses relevant to our area. This article will give a quick overview of the pathway as a refresher as we head into summer and tick season!