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Banbury S, Milgraum DM, Lewis DJ, Queenan M, Treat JR. Post-streptococcal small-vessel vasculitis in a 16-month-old with associated intussusception and hypertension: Henoch Schönlein purpura? Pediatr Dermatol 2024. [PMID: 38631675 DOI: 10.1111/pde.15599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 02/24/2024] [Indexed: 04/19/2024]
Abstract
Henoch Schönlein purpura (HSP), also known as IgA vasculitis, is a systemic small-vessel vasculitis typically occurring in children 3-15 years of age, with peak incidence at 4-6 years. It is characterized by a constellation of symptoms including palpable purpura, arthralgias or arthritis, abdominal pain including intussusception, and renal involvement. We report a patient with these clinical findings whose IgA immunofluorescence was negative but with a presumptive diagnosis of HSP at 16 months of age, significantly younger than the classic population. This condition rarely affects this age group, and we highlight the importance of considering vasculitis in children of all ages, as a failure to diagnose could lead to insufficient long-term monitoring, particularly regarding renal function.
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Affiliation(s)
- Sara Banbury
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David M Milgraum
- Section of Pediatric Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Daniel J Lewis
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maria Queenan
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - James R Treat
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Section of Pediatric Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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2
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Kumar R, Raj A, Kumar M, Kumar D, Bhattacharya S. Unraveling acute hemorrhagic edema of infancy in the COVID-19 era: Insights from a tribal area in Jharkhand. J Family Med Prim Care 2023; 12:3409-3411. [PMID: 38361863 PMCID: PMC10866281 DOI: 10.4103/jfmpc.jfmpc_114_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 06/21/2023] [Accepted: 07/25/2023] [Indexed: 02/17/2024] Open
Abstract
Acute hemorrhagic edema of infancy (AHEI) is a benign and rare presentation of leukocytoclastic vasculitis that usually affects children between 4 months and 24 months of age. It is characterized by purpuric and ecchymotic lesions that mainly involve the distal extremities, the face, and the ears. It usually follows some viral or bacterial infection. Here, we report a case of a 25-month-old male child who presented with mild grade fever and upper respiratory tract infection symptoms. Subsequently, he developed progressive purpuric and ecchymotic lesions over his body, mainly on his lower limbs and face. Laboratory tests were done, showing elevated C-reactive protein and erythrocyte sedimentation rate with rest of normal results. In view of patients having respiratory symptoms, reverse-transcriptase polymerase chain reaction of a nasopharyngeal swab for coronavirus disease 2019 (COVID-19) was done, which came out to be positive. The baby received supportive care only. He gradually improved and was discharged successfully. AHEI may be a possible after effect of COVID-19 infection.
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Affiliation(s)
- Rajan Kumar
- Department of Pediatrics, All India Institute of Medical Sciences, Deoghar, Jharkhand, India
| | - Akanksha Raj
- Department of OBS and Gynae, Jharkhand, ANMCH, Gaya, Bihar, India
| | - Manoj Kumar
- Department of Pediatrics, All India Institute of Medical Sciences, Deoghar, Jharkhand, India
| | - Deepak Kumar
- Department of Physical Medicine and Rehabilitation (PMR), All India Institute of Medical Sciences, Deoghar, Jharkhand, India
| | - Sudip Bhattacharya
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Deoghar, Jharkhand, India
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3
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Tumminello M, Lo Scalzo L, Gangemi A, Matina F, Termini D, Guardino M, Piraino G, Giuffrè BL, Corsello G. Acute hemorrhagic edema of infancy (AHEI): Alarming cutaneous presentation of a benign and self‐limited disease. Clin Case Rep 2022; 10:e6383. [PMCID: PMC9743317 DOI: 10.1002/ccr3.6383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 04/04/2022] [Accepted: 06/11/2022] [Indexed: 12/14/2022] Open
Abstract
Acute hemorrhagic edema of infancy (AHEI) is a cutaneous leukocytoclastic vasculitis. We report on an 11‐month‐old boy, presenting the classical feature of AHEI with alarming cutaneous presentation, but good clinical condition. Early recognition is crucial to avoid unnecessary medical investigations or therapies, as well as to identify potentially severe complications.
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Affiliation(s)
- Mario Tumminello
- Neonatology and Neonatal Intensive Care UnitAOOR Villa Sofia‐CervelloPalermoItaly
| | - Lucia Lo Scalzo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D'Alessandro”University of PalermoPalermoItaly
| | - Antonella Gangemi
- Neonatology and Neonatal Intensive Care UnitAOOR Villa Sofia‐CervelloPalermoItaly
| | - Federico Matina
- Neonatology and Neonatal Intensive Care UnitAOOR Villa Sofia‐CervelloPalermoItaly
| | - Donatella Termini
- Neonatology and Neonatal Intensive Care UnitAOOR Villa Sofia‐CervelloPalermoItaly
| | - Melania Guardino
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D'Alessandro”University of PalermoPalermoItaly
| | - Giuseppe Piraino
- Neonatology and Neonatal Intensive Care UnitAOOR Villa Sofia‐CervelloPalermoItaly
| | - Bianca Lea Giuffrè
- Neonatology and Neonatal Intensive Care UnitAOOR Villa Sofia‐CervelloPalermoItaly
| | - Giovanni Corsello
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D'Alessandro”University of PalermoPalermoItaly
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Bronz G, Consolascio D, Bianchetti MG, Rinoldi PO, Betti C, Lava SAG, Milani GP. Köbner and Pastia Signs in Acute Hemorrhagic Edema of Young Children: Systematic Literature Review. CHILDREN (BASEL, SWITZERLAND) 2022; 9:265. [PMID: 35204985 PMCID: PMC8870368 DOI: 10.3390/children9020265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/09/2022] [Accepted: 02/11/2022] [Indexed: 12/31/2022]
Abstract
Acute hemorrhagic edema of young children, a benign skin-limited vasculitis, predominantly affects children 2 years of age or younger. The prevalence and clinical features of the Köbner and Pastia signs have never been systematically investigated in this vasculitis. To address this issue, we analyzed the data contained in the Acute Hemorrhagic Edema Bibliographic Database, which incorporates all reports on hemorrhagic edema published after 1969. A total of 339 cases (236 males and 103 females; 11 (8-18) months of age; median and interquartile range) were documented with at least 1 photograph and therefore included in this analysis. The Köbner sign occurred in 24 cases (14 males and 10 females; 11 (7-17) months of age), the Pastia sign in 51 cases (39 males and 12 females; 11 (8-15) months of age), and both Köbner and Pastia signs in 8 cases (7 males and 1 female; 11 (7-17) months of age). The lower legs, thighs, waistline, and groin were the regions that were most commonly affected with the Köbner sign, while the ankle, feet, cubital fossa, and elbow were most affected with the Pastia sign. The Köbner and Pastia signs are clinically relevant; they occur in about every fourth child affected with hemorrhagic edema and do not influence the disease progression.
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Affiliation(s)
- Gabriel Bronz
- Pediatric Institute of Southern Switzerland, Ospedale San Giovanni, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland; (M.G.B.); (P.O.R.); (C.B.)
- Family Medicine Institute, Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland;
| | - Danilo Consolascio
- Family Medicine Institute, Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland;
| | - Mario G. Bianchetti
- Pediatric Institute of Southern Switzerland, Ospedale San Giovanni, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland; (M.G.B.); (P.O.R.); (C.B.)
- Family Medicine Institute, Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland;
| | - Pietro O. Rinoldi
- Pediatric Institute of Southern Switzerland, Ospedale San Giovanni, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland; (M.G.B.); (P.O.R.); (C.B.)
- Family Medicine Institute, Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland;
| | - Céline Betti
- Pediatric Institute of Southern Switzerland, Ospedale San Giovanni, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland; (M.G.B.); (P.O.R.); (C.B.)
- Family Medicine Institute, Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland;
| | - Sebastiano A. G. Lava
- Pediatric Cardiology Unit, Department of Pediatrics, Centre Hospitalier Universitaire Vaudois, University of Lausanne, 1011 Lausanne, Switzerland;
| | - Gregorio P. Milani
- Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy
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Shah P, McGlamry K, Thakral A. Acute Hemorrhagic Infancy of Edema: A Purpuric Rash in 6-Month-Old Infant. J Investig Med High Impact Case Rep 2021; 9:23247096211017413. [PMID: 34018831 PMCID: PMC8145611 DOI: 10.1177/23247096211017413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Acute hemorrhagic edema of infancy (AHEI) is a cutaneous leukocytoclastic vasculitis presenting with purpura, ecchymosis, fever, and edema. Pediatricians must effectively differentiate AHEI from other diseases that have similar presentations but are more severe in order to treat appropriately without overutilizing expensive, unnecessary diagnostic tests. In this article, we describe a case of a 6-month-old previously well male who presented to our institution with a worsening rash and fever. In this case, the patient’s age and benign clinical manifestations without systemic involvement favored the diagnosis of AHEI over more serious conditions. This case is a valuable example of the clinical findings of AHEI and the effectiveness of conservative therapy once a diagnosis is made for pediatricians, especially emergency and urgent care physicians.
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Affiliation(s)
- Pareen Shah
- Emory University, Atlanta, GA, USA.,Children's Healthcare of Atlanta, Atlanta, GA, USA
| | | | - Amit Thakral
- Emory University, Atlanta, GA, USA.,Children's Healthcare of Atlanta, Atlanta, GA, USA
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Saraiva BM, Lobato MB, Santos E, Garcia AM. Acute haemorrhagic oedema of infancy as a manifestation of COVID-19. BMJ Case Rep 2021; 14:e241111. [PMID: 33782070 PMCID: PMC8009209 DOI: 10.1136/bcr-2020-241111] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
| | | | - Elsa Santos
- OutPatient Paediatrics, Hospital do Litoral Alentejano, Santiago do Cacem, Setúbal, Portugal
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Carboni E, Scavone M, Stefanelli E, Talarico V, Zampogna S, Galati MC, Raiola G. Case Report: Acute hemorrhagic edema of infancy (Seidlmayer purpura) - a dramatic presentation for a benign disease. F1000Res 2020; 8:1771. [PMID: 31942241 PMCID: PMC6944248 DOI: 10.12688/f1000research.20645.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2019] [Indexed: 11/20/2022] Open
Abstract
We present a case of an 11-month-old girl who was referred to our unit for an erythematous rash that appeared on the face and extremities. Personal and family history was not relevant. Laboratory tests were normal. During recovery, diameter and colour intensity of the cutaneous lesions increased, but after some weeks, lesions had a self-limited resolution without any treatment. Based on clinical and laboratory findings, a diagnosis of acute hemorrhagic edema of infancy (AHEI) was made. AHEI is a rare cutaneous leukocytoclastic vasculitis that usually affects children aged between 4 and 24 months. Etiology is unknown but almost of 75% of cases are preceded by infectious episodes, vaccinations or use of medications. In contrast to the dramatic cutaneous eruption, clinical conditions are usually optimal. Classically, AHEI is characterized by a triad of symptoms: fever, edema and purpura. Skin lesions are erythematous, annular, medallion-like, purpuric plaques that have a rapid onset and appear on the face and extremities, sparing trunk and mucosal membranes. Initially interpreted as a variant of Henoch-Schönlein purpura, now it is considered a distinct disease. In the majority of cases the disease is benign and self-limited without a visceral involvement, so a conservative approach is most often chosen.
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Affiliation(s)
- Elena Carboni
- Department of Pediatrics, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Maria Scavone
- Department of Pediatrics, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Ettore Stefanelli
- Department of Pediatrics, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | | | - Stefania Zampogna
- Department of Pediatrics, Pugliese Ciaccio Hospital, Catanzaro, Italy
| | - Maria Concetta Galati
- Department of Pediatric Oncology and Hematology, Pugliese Ciaccio Hospital, Catanzaro, Italy
| | - Giuseppe Raiola
- Department of Pediatrics, Pugliese Ciaccio Hospital, Catanzaro, Italy
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Acute Hemorrhagic Edema of Infancy: A Two-Case Report. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2018; 52:220-223. [PMID: 32595402 PMCID: PMC7315089 DOI: 10.5350/semb.20170419063548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 04/19/2017] [Indexed: 11/16/2022]
Abstract
Acute hemorrhagic edema of infancy is a leukocytoclastic small vessel vasculitis of young children that is limited to the skin, generally has a benign course without systemic involvement, and does not require treatment. It is characterized by fever, edema of the lower extremities, and wide purpuric rash of the skin. It typically affects infants aged 6–24 months with a history of recent respiratory system illness. An 11-month-old and a 57-month-old cases with acute hemorrhagic edema of infancy who concurrently have a lower respiratory system infection are presented in this case report.
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Al Murayshid AI. Acute Hemorrhagic Edema with extensive truck involvement and Rhinovirus infection association. JOURNAL OF DERMATOLOGY & DERMATOLOGIC SURGERY 2017. [PMCID: PMC7147234 DOI: 10.1016/j.jdds.2016.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Acute Hemorrhagic Edema (AHE) is a rare form of leukocytoclastic vasculitis with an unknown etiology. There are various possible triggers associated with the development of AHE such as Upper Respiratory Tract related infections which have been reported in the literature. A typical case of AHE is a child less than 2 years of age having the symptoms of fever, Acral Targetoid Purpura, and Edema. The course of this illness is benign with a complete resolution within few weeks. This case report involves a patient having the classical symptoms of fever, Purpura and Edema, but with an unusual extensive truncal involvement. Moreover, Rhinovirus infection testing was positive in the child’s case. The presence of the virus gives a suspicion of being the possible trigger for the boy’s AHE. In the previous hospital, the treatment started with steroid for a course of one week without a significant improvement which brought the patients to the Emergency department. A decision of continuing a supportive treatment led to a complete resolution. After 3 weeks the AHE symptoms were gone without any complications.
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Kretschmer AM, Krause B, Buchauer F, Seeliger S. Akutes hämorrhagisches Ödem des Kleinkindes. Monatsschr Kinderheilkd 2016. [DOI: 10.1007/s00112-015-0015-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Cunha DFS, Darcie ALF, Benevides GN, Ferronato AE, Hein N, Lo DS, Yoshioka CRM, Hirose M, Cardoso DM, Gilio AE. Acute Hemorrhagic Edema of Infancy: an unusual diagnosis for the general pediatrician. AUTOPSY AND CASE REPORTS 2015; 5:37-41. [PMID: 26558246 PMCID: PMC4636105 DOI: 10.4322/acr.2015.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 08/28/2015] [Indexed: 11/23/2022] Open
Abstract
Acute Hemorrhagic Edema of Infancy (AHEI) is a rare leukocytoclastic vasculitis, clinically characterized by the classical triad: palpable purpuric skin lesions, edema and fever, and is commonly misdiagnosed as Henoch-Schönlein purpura. In addition to its sudden onset, AHEI is also characterized by its self-limited course with complete and spontaneous recovery occurring between 1 and 3 weeks. Because of the scarcity of studies on therapy with corticosteroids, the conservative approach is usually recommended. The authors report an unusual case of an one-year-old boy who presented with typical cutaneous rash of AHEI and orchitis, the latter showing complete resolution after less than 24 hours of prednisolone therapy. The authors call attention to this entity mainly as a differential diagnosis of Henoch-Schönlein purpura and to the importance of new studies to establish the benefits of corticosteroid therapy for AHEI.
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Affiliation(s)
- Diego Fontana Siqueira Cunha
- Department of Pediatrics - Hospital das Clínicas - Faculty of Medicine - Universidade de São Paulo, São Paulo/SP - Brazil
| | | | | | | | - Noely Hein
- Division of Pediatrics - Hospital Universitário - Universidade de São Paulo, São Paulo/SP - Brazil
| | - Denise Swei Lo
- Division of Pediatrics - Hospital Universitário - Universidade de São Paulo, São Paulo/SP - Brazil
| | | | - Maki Hirose
- Division of Pediatrics - Hospital Universitário - Universidade de São Paulo, São Paulo/SP - Brazil
| | - Debora Morais Cardoso
- Division of Pediatrics - Hospital Universitário - Universidade de São Paulo, São Paulo/SP - Brazil
| | - Alfredo Elias Gilio
- Faculty of Medicine - Universidade de São Paulo, São Paulo/SP - Brazil . ; Division of Pediatrics - Hospital Universitário - Universidade de São Paulo, São Paulo/SP - Brazil
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