June 2015

Purpura hemorrhagica: a case of Ledum

by Gwyneth Evans

A., a three-and-a-half-year-old girl, had been diagnosed with Henoch-Schonlein purpura (HSP) when I visited her in hospital.  

She had been admitted because of the pain, swelling and ‘bruising’ of her lower limbs, with swelling from the knees down, particularly both feet. She had pain in her joints, worse from touch, as well as stiffness, worse after sleep. She refused to walk or to stand because of the pain and swelling, as well as what appeared to be a weakness of the legs. A. just wanted to be held by her mother, and if put down as if to stand, her legs simply folded. It was difficult to judge whether this was due weakness or pain.

The purpura appeared as purplish-blue spots or patches, which looked somewhat like bruises, mostly on her legs, though she did develop some on her buttocks as well. The discoloured patches varied in size from 1.5 to 3 cm diameter, in irregular shapes.

In general, A. is an outgoing, sociable child, who easily talks to adults. She has an ability to chat with her grandparents, who died a few years before she was born.

The remedy quickly given was Phosphorus as it fitted both the rubric ‘EXTREMITIES, Discoloration, lower limbs, purpura haemorrhagica’, and the type of child, including the clairvoyance.

This remedy helped A. to feel better in herself. “It keeps her calmer,” her mother said, and “it made a big difference.” She was more settled and less restless, her eating was back to normal and the swelling diminished. However, she remained stiff on waking and she required conventional pain relief quite frequently, otherwise she would stiffen up again.

She was still getting more spots on her abdomen and had 5cm large patches across her buttocks. She had some “lumps that look a bit like insect bites but they aren’t doing what a bite would normally do on A.” She would usually have a strong reaction to insect bites, with a lot of itching and scratching. Her eye was swollen and she had swelling on the bridge of her nose and forehead. She complained of a sore tummy.

At the hospital, the parents were told that the cause was unknown. At this point, I inquired more deeply into any possible causation(s); her parents had been thinking about this too, wondering if the illness had anything to do with some weedkiller they had sprayed, or some insect repellent sprayed on her skin. Eight months ago, A. had had what appeared to be a scratch on her hand that grew to 2.5 cm diameter. Six months ago, she had an infected blister on her heel that swelled up and took a time to improve.

Pondering all of this, I slept on it, waking the next morning thinking of Ledum. She needs Ledum. Sometimes, the simplest answers elude us for a time.

Ledum from Morrison Desktop Guide:

Purple discoloration and swelling. Ecchymosis and bruising. Purpura.
Aetiology of insect bites, puncture wounds.
Rheumatism, mainly of lower extremities. Rheumatism with pain and stiffness. Rheumatism ascends during the course of an illness to more proximal joints.

Prescription: Ledum 200C

Follow-up from mother three weeks later
“Anna is doing fantastic. There was an almost instant change after the remedy. Overnight, she became more alert, the bruising slowed down, and she was able to function so much better. Pretty much from then on, she has not needed pain relief.  For the past three weeks, since taking the remedy, she has not had any new bruising. This is about six weeks after the whole thing started. There are still some faint marks where the bruises were on her thighs. I don’t think it would have cleared so quickly without your help.”

*The Merck Manual, seventeenth edition, defines Henoch-Schonlein purpura as follows: “An acute or chronic vasculitis affecting primarily small vessels of the skin, joints, G.I. tract and kidney. The disease primarily affects young children but may affect older children and adults. An acute respiratory infection precedes purpura in a high proportion of affected young children. Less commonly, a drug may be the inciting agent, and a drug history should always be obtained.”

Note: this case has been previously published in Hpathy.

Photo: Wikipedia
Henoch-Schonlein purpura; Madhero88; CC BY-SA 3.0

Keywords: purpura hemorrhagica, bruising, purple discoloration, swelling, ecchymosis, insect bites, rheumatism


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