Acute haemorrhagic oedema in a 5-year-old boy

Abstract

Acute haemorrhagic oedema (AHO) of the skin usually occurs in infancy, but it may occur in older children. We report the case of a 5-year-old boy with AHO, to illustrate that the condition can occur in older children.A 5-year-old boy presented with a 2-week history of an eruption appearing shortly after a mild upper respiratory infection. Tender oedema, particularly of the hands and feet, had developed, which was already settling spontaneously by presentation. He was otherwise well, and had no relevant history or allergies.On physical examination, he had widespread, sizable circular areas of slightly swollen erythema, some of which had evolved into a bruise-like appearance (Fig. 1a). Within the preceding few days, he had developed a bright red discoloration of the scrotum, with associated oedema of the penis (Fig. 1b). He was apyrexial and there was a remarkable lack of symptoms, given the extent and apparent severity of the eruption. Urinalysis excluded haematuria or proteinuria. Routine blood parameters, including inflammatory markers, were within normal limits. No histology was performed. After 1 week the lesion on the scrotum had resolved spontaneously, and no new lesions developed. The other lesions settled within 3 weeks. This episode was considered to be characteristic of AHO.AHO of the skin was first described in an infant by Snow 1 in 1913, and useful reviews have been published recently. [2][3][4] The majority (80%) of cases occur in children aged < 2 years, and the condition has become known as 'acute haemorrhagic oedema of infancy', but cases have been reported in children up to the age of 60 months. 3 The typical presentation is with sizable lesions (up to a few centimetres in diameter) of inflammatory oedema and ecchymotic purpura, mainly of the limbs and face. Some lesions may be targetoid. In boys, scrotal lesions are common. In around three-quarters of patients, there is a history of a preceding respiratory infection, medication use or immunization. A striking feature is the contrast between the severity of the cutaneous findings and the general good health of the child. Involvement of C P D Figure 1 (a) Widespread sizable circular areas of slightly swollen erythema, some of which had evolved into a bruise-like appearance; (b) bright-red discoloration of the scrotum with associated oedema of the penis. CED Clinical and Experimental Dermatology

Common pathway coagulopathy and hemorrhagic edema of infancy

“…This case provides an interesting illustration of a rare inherited coagulopathy, presenting in the context of a viral illness with a similar phenotype to acute hemorrhagic edema of infancy (AHOI), although atypical in light of her age and markedly deranged coagulation studies. AHOI is an immune‐mediated small vessel vasculitis that typically presents with purpura, edema, and fever in children from 4 months to 2 years, although cases have been described up to 5 years of age 2 . Viral upper respiratory infections are the most common trigger, but bacterial infections, medications, and immunizations have been associated.…”

“…AHOI is an immune‐mediated small vessel vasculitis that typically presents with purpura, edema, and fever in children from 4 months to 2 years, although cases have been described up to 5 years of age. 2 Viral upper respiratory infections are the most common trigger, but bacterial infections, medications, and immunizations have been associated. Although sharing features with Henoch–Schönlein purpura, systemic involvement is less frequent, it is not associated with renal disease 2 and usually follows a benign self‐limiting course.…”

“… 2 Viral upper respiratory infections are the most common trigger, but bacterial infections, medications, and immunizations have been associated. Although sharing features with Henoch–Schönlein purpura, systemic involvement is less frequent, it is not associated with renal disease 2 and usually follows a benign self‐limiting course. 3 …”