To the Editor.—Katz et al1 provide a definitive study of the surgical implications of Henoch-Schönlein purpura (HSP). I am concerned, however, with their characterization of abdominal or scrotal exploration performed for appendicitis or testicular torsion in patients later found to have HSP. While the results of these operations were normal, I do not agree that they were therefore unnecessary.
Henoch-Schönlein purpura is a condition for which the clinical tetrad of abdominal pain, rash, arthralgia, and hematuria is diagnostic. However, in the study by Katz et al, only 22% of their 110 patients displayed all four of these symptoms and signs, and in fact, another 22% had only one of these manifestations of the disease. The diagnosis of appendicitis and testicular torsion is still primarily a clinical one to be followed up immediately with operative intervention, and I doubt that it is the intent of Katz and colleagues to