Acute Haemorrhagic Oedema Of Infancy Research Articles

Una “vistosa” vasculite con edema, che riguarda gli arti e il viso e risparmia il tronco

Acute haemorrhagic oedema of infancy (AHEI) is a small vessel vasculitis that affects boys between 4 months and 2 years. It presents with a characteristic purpuric skin rash but with marked bruising and “typical” localizations in auricles and is often accompanied by oedema of face and extremities. It is typically post-infectious, especially after infections of the upper respiratory tract and rarely can be associated with gastrointestinal, renal, articular or testicular complications. The paper reports the case of a 2-year-and-5-month-old boy who, 5 days after the resolution of a febrile infection of the upper airways (with subsequent detection of positive IgM and IgG serology for SARS-Cov-2), presented with a rash with ecchymotic/purpuric lesions in his lower limbs, face and auricles associated with intense arthralgia, arthritis of a knee and deterioration of general conditions. The diagnosis of acute infantile haemorrhagic oedema was clear but the clinical presentation required an “important” therapeutic approach with intravenous steroids and an infusion of immunoglobulins.

Acute haemorrhagic oedema of infancy with lower gastrointestinal bleed: A clinical oddity.

Acute haemorrhagic oedema of infancy with lower gastrointestinal bleed: A clinical oddity.

Acute haemorrhagic oedema of infancy with lower gastrointestinal bleed: A clinical oddity

Acute haemorrhagic oedema of infancy with lower gastrointestinal bleed: A clinical oddity

A Case of Human Metapneumovirus Associated with Acute Haemorrhagic Oedema of Infancy

Acute Haemorrhagic oedema of infancy (AHOI) is a cutaneous leukocytoclastic vasculitis, clinically characterized by the acute development of peripheral oedema and targetoid purpuric lesions on the face and extremities .

Leukocytoclastic vasculitis in children: clinical characteristics, subtypes, causes and direct immunofluorescence findings of 56 biopsy-confirmed cases.

Leukocytoclastic vasculitis (LCV) in children is a complex group of conditions. This study presents the demographics, clinical features, direct immunofluorescence (DIF) results and suspected aetiologies of 56 biopsy-confirmed cases of leukocytoclastic vasculitis in children. Retrospective review of 56 children seen at Mayo Clinic in Rochester, Minnesota, from 1993 to 2013 with clinical features and cutaneous biopsy consistent with LCV. Twenty-seven (48%) cases were found to be due to IgA vasculitis (Henoch-Schonlein purpura). The remaining cases were found to be due to cutaneous small-vessel vasculitis (n = 19, 34%), urticarial vasculitis (n = 5, 9%), ANCA-associated vasculitis (n = 4, 7%) and acute haemorrhagic oedema of infancy (n = 1, 2%). IgA vasculitis was found to be associated with abdominal pain (P = 0.008), whereas the non-IgA vasculitis group was associated with headache (P = 0.052). Children with IgA vasculitis had palpable purpura (P = <0.001), petechia (P = 0.057), vesicles (P = 0.009) and involvement of the buttock (P = 0.004) more frequently than the non-IgA vasculitis group. On DIF, perivascular IgA was positive in IgA vasculitis compared to non-IgA vasculitis cases (P = <0.001), the other conjugates were similar between the two groups. The most common subtype of biopsy-confirmed LCV in children is IgA vasculitis. Clinical features, exam characteristics and DIF results can be helpful in determining the subtype of cutaneous vasculitis in children.

Striking but benign: acute haemorrhagic oedema of infancy

A previously healthy 6-month-old boy presented in September, 2014, with indurated and tender oedema of the left hand, associated with a rapidly spreading purpuric rash on the dorsum. He also had swelling of one side of his face, but examination was otherwise normal. Beginning 4 days previously he had had a 3-day upper respiratory tract infection, with no associated fever; his parents denied trauma or previous drug use. Blood tests including full blood count, coagulation studies, and circulating immune complexes were normal, apart from moderate thrombocytosis (platelets 518 × 109/L; normal range 168–392 × 109/L) and normochromic normocytic anaemia (haemoglobin 99 g/L; 105–135 g/L). Urinalysis was normal. We diagnosed acute haemorrhagic oedema of infancy, a leukoclastic small-vessel vasculitis that was initially thought to be a benign variant of Henoch-Schonlein purpura, but is now considered a distinct entity. Acute haemorrhagic oedema of infancy typically aff ects children between 4 and 24 months of age, whereas Henoch-Schonlein purpura is more common in children aged 3 to 6 years. Unlike Henoch-Schonlein purpura, systemic involvement is rare in acute haemorrhagic oedema of infancy; symptoms are usually restricted to the skin. Cutaneous lesions are typically large nummular red or purpuric plaques or cockade-like lesions involving the face, ears, and limbs, but sparing the trunk and mucosa. Non-pitting oedema is more frequently noted on the arms and legs but can involve the face. In Henoch-Schonlein purpura the legs and buttocks are more commonly aff ected. Patients with acute haemorrhagic oedema of infancy usually look clinically well. Lesions usually resolve within 1–3 weeks without treatment. Long-term sequelae have not been reported. In our patient, the purpuric rash resolved within 4 weeks and at follow-up 6 months later he had had no further symptoms. After excluding infectious, immune, or infl ammatory causes of purpuric rashes, physicians should consider this rare, striking but benign diagnosis when faced with a well-appearing infant with purpuric plaques and non-pitting oedema.

Acute haemorrhagic oedema of infancy in a 5-week-old boy referred to the Child Protection Unit

We describe the case of a 5-week-old infant boy presenting with purpura and oedema to both hands and torso. He was otherwise well, with no antecedent history of illness or trauma. Laboratory investigations were within normal limits. A review by the Child Protection Unit was organised during his admission for consideration of inflicted trauma as a cause of the lesions; this was felt most unlikely. A clinical diagnosis, following a dermatology consultation, of acute haemorrhagic oedema of infancy (AHO) was made.

Mycoplasma pneumoniae: an aetiological agent of acute haemorrhagic oedema of infancy

Acute haemorrhagic oedema of infancy (AHEI) is considered a separate clinical entity among cutaneous small vessel vasculitis of childhood. It usually occurs in children younger than 2 years of age, with spontaneous recovery occurring within a few weeks. A history of recent upper respiratory or urinary tract infections or immunisation is found in most patients. Although Mycoplasma pneumoniae has been linked to a wide array of skin eruptions or diseases, it is not recognised as a possible cause of acute haemorrhagic oedema of infancy. The authors report a child with AHEI and a concurrent M. pneumoniae infection.

Acute purple and perplexing

Introduction Acute haemorrhagic oedema of infancy (AHOI) is an infrequently reported vasculitis (leucocytoclastic) in children less than 3 years of age. It is generally preceded by a variety of infections or drug intake or immunisations. It is characterised by abrupt onset of fever, purpuric lesions and peripheral oedema of extremities and face that may be confused with other causes of purpura. We report 3 cases of AHOI to highlight the variable presentation and emphasise the benign course. Cases 1. A 12 months old male infant presented with a one day history of non-blanching rash on the legs, associated with preceding coryzal symptoms, pyrexia and persistent discharge from the left ear despite oral antibiotics. The rash was initially felt to be Henoch-Schonlein purpura (HSP). 2. A 13 months old female presented with itchy rash and intermittent fever with preceding history of coryzal symptoms. The initial diagnosis of erythema multiforme was revised as she developed a florid annular erythema and widespread purpura over the next twenty four hours. 3. A 3 year old male presented with an urticarial rash and pyrexia. He was managed conservatively as viral urticaria. The rash dramatically spread all over the body as purpura developed. He was treated with intravenous antibiotics for presumed meningococcal sepsis. However, the rash continued to evolve and he remained otherwise well. In all these cases urine analysis and blood pressure were normal and there was complete resolution of the skin lesions after one to two weeks. Conclusion AHOI should be considered in differential diagnosis for evaluation of the child with purpuric lesions. A confident clinical diagnosis may require the support of an experienced dermatologist and is usually possible without requiring a skin biopsy. Visceral involvement is rare and systemic corticosteroids are unnecessary due to spontaneous resolution. In our experience it is not as uncommon as some authors suggest. Familiarity with its variable clinical features is of value to the paediatrician and dermatologist seeing these children in the acute medical setting.

Acute haemorrhagic oedema of infancy associated with Wiskott‐Aldrich syndrome

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

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.