Review and case report of acute hemorrhagic edema of infancy. A benign cause of a striking rash.

Abstract

Acute hemorrhagic edema of infancy is a non common, self limiting, cutaneous, leukocytoclastic vasculitis affecting children younger than 2 years of age. It has a worrisome presentation with a purpuric rash of sudden onset and concomitant edema limited to the face and lower extremities, often accompanied by fever. Although patients’ general condition is characteristically good, this condition can cause significant concern to parents and clinicians mimicking serious disease such as meningococcemia.

We report one case of acute hemorrhagic edema of infancy. Our 12-month-old male patient presented with multiple red and purple-colored lesions on both lower extremities, including feet. He had a 6-day history of rhinitis and cough. His past medical history and family history were unremarkable. The patient was afebrile, in good condition. Except for the presence of multiple ecchymotic, purpuric patches on both lower extremities accompanied by non-pitting edema, the remainder clinical examination revealed no abnormal findings. Laboratory studies revealed leukocytosis with neutrophilia, thrombocytosis and mild elevation of inflammatory markers. Biochemical and immunological parameters, clotting screening and urinalysis were normal. The fecal occult blood test was negative, blood cultures were sterile and the abdominal ultrasound was unremarkable. With the diagnosis of acute hemorrhagic edema of infancy confirmed by the dermatologist, our patient received only supportive care and was discharged one week later with regression of the lesions. Follow up for one month with weekly clinical and laboratory evaluation revealed complete resolution of symptoms and no sequelae. Although acute hemorrhagic edema of infancy is a rare clinical entity, it should be included in the differential diagnosis of hemorrhagic rash in children younger than 2 years of age. Thus, its early identification in view of its benign course, prevents unnecessary investigations and medical treatment.