Oral 12, Acute haemorrhagic oedema of infancy: an important differential diagnosis to nonaccidental injury

Abstract

Acute haemorrhagic oedema of infancy (AHOI) is a rare cutaneous disease that often goes unrecognized by paediatricians and sometimes dermatologists.1 The dramatic presentation can then lead to unnecessary investigations, as well as concerns about nonaccidental injury. We present some clinical cases to illustrate the typical clinical features. In 75% of reported cases of AHOI there is an association with recent infection, but other precipitating factors include drugs and vaccines. Patients are usually under the age of 2 years and present typically with erythematous rosette-like (en cocarde) eruptions over the face, ears, hands and lower legs. Localized oedema and ecchymoses here may raise unnecessary concerns about nonaccidental injury. More widespread involvement may mimic conditions such as necrotic meningococcal purpura, Henoch–Schonlein purpura, erythema multiforme, urticarial vasculitis, Sweet's syndrome or systemic lupus erythematosus. AHOI has a very good prognosis and complications are rarely reported.1,2 To date, there are few published photographic examples of this condition. Our cases illustrate classical features helpful in the diagnosis of AHOI, where the dermatologist has a valuable role to play. With acknowledgment to Dr Caroline Mills. References 1 McDougall CM, Ismail SK, Ormerod A. Acute haemorrhagic oedema of infancy. Arch Dis Child 2005; 90:316. 2 Legrain V, Lejean S, Taieb A et al. Infantile acute hemorrhagic edema of the skin: study of ten cases. J Am Acad Dermatol 1991; 24:17–22.