Thread by @guerreroespejo

A 12-MO♀️ girl, immunization for hepatitis B, 2 weeks prior: a rapidly spreading, nonblanching, nonpalpable, purpuric rash over legs & cheeks surrounded by edema, 37.6°C, nontoxic in appearance

Leukocytosis,⬆️CRP
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#dermatology #Emergency #Pediatrics doi.org/10.1093/cid/ci…

The next day, the hemorrhagic rash became palpable
Pharyngeal PCR:➕for enterovirus
🔬 of purpuric lesions: leukocytoclastic vasculitis, & DI studies showed vascular wall fibrinogen deposition, consistent with ACUTE HEMORRHAGIC EDEMA OF INFANCY (AHEI)
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#pediatric #IDtwitter

Typical patient of ACUTE HEMORRHAGIC EDEMA OF INFANCY:
✔️6–24 months of age,
✔️during winter,
✔️nontoxic presentation,
✔️low-grade fever,
✔️abrupt onset of large purpuric skin lesions,
✔️and edema in face and extremities
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doi.org/10.1093/cid/ci…
#MedTwitter #pediatria

ACUTE HEMORRHAGIC EDEMA OF INFANCY is a self-limited disease and the prognosis is excellent.

Complete recovery usually occurs within 1–3 weeks
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#MedStudentTwitter #MedicalStudents

ACUTE HEMORRHAGIC EDEMA OF INFANCY
✔️associated with some viruses & bacteria (adenovirus, cytomegalovirus, herpes simplex virus, varicella zoster virus, tuberculosis, streptococci, staphylococci, pneumococcus)
✔️but the etiology of this disease remains unknown
5/9

#microbiology

AHEI triggered by:
📌infection (respiratory infection, urinary tract infection, etc.), vaccination (H1N1, MMR, BCG, DTaP, polio, H. influenzae), or
📌drug intake (penicillin, cephalosporin, TMP/SMX, etc.),
which reveal a possible immune-mediated pathophysiology
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#Doctor

The girl had enterovirus isolated from the throat, and hepatitis B vaccine was given 2 weeks before admission, signifying a possible association with acute hemorrhagic edema of infancy.
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#microbiology

Diagnosis is based on clinical features but if diagnosis is unclear, a skin biopsy of the rash will be helpful.

The most common histopathological description is perivascular neutrophilic infiltration with nuclear fragments in the vascular wall and fibrinoid necrosis
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Differential diagnosis includes Sweet syndrome, erythema multiforme, purpura fulminans, Kawasaki disease, & meningococcal septicemia

Acute hemorrhagic edema of infancy is a benign, self-limited leukocytoclastic #vasculitis of small vessels affecting #children <2 years of age
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