Acute Onset of a Hemorrhagic Rash in an Otherwise Well-Appearing Infant

Abstract

10-month-old, previously healthy girl presented withacute onset of a diffuse, hemorrhagic rash. Physicalexamination revealed multiple non-blanchable redplaques on her bilateral hands, feet, cheeks, and ears(Figure 1; and Figures 2 and 3; available at www.jpeds.com). A small red papule was present on the lower lip.Minimal edema of the hands and feet was also present, butno involvement of the conjunctiva, oropharynx, or othermucous membranes was noted (Figure 4; available at www.jpeds.com). The patient was well-appearing, playful, andafebrile, with stable vital signs.This patient had been treated 1 week prior for congestion,conjunctivitis, and otitis media with both moxifloxacin andamoxicillin/clavulanate.Shehadnohistoryofvomiting,diar-rhea, melena, or hematochezia. Urine dipstick was negativefor blood and protein.Thispatient’sclinicalpresentationwasconsistentwithadi-agnosis of acute hemorrhagic edema of infancy (AHEI), orFinkelstein’s disease. AHEI is a benign, small vessel vasculitischaracterizedbytheacuteonsetofhemorrhagic,targetoid,orrosette-shaped lesionsthat aremost commonlyfoundontheface, ears, and extremities.