Acute Hemorrhagic Edema of Infancy: Report of 4 Cases and Review of the Current Literature

Abstract

Acute hemorrhagic edema of infancy (AHEI) is a cutaneous leukocytoclastic vasculitis that usually occurs in children younger than 2 years of age. It is a rare disease characterized by mild fever, a violent onset of hemorrhagic skin lesions, and edema usually followed by a spontaneous and complete recovery. Although the etiology is unknown, AHEI often follows infections, drug treatment, or vaccination. In the present report, the authors describe 4 cases of AHEI and review the relevant literature.

Acute Hemorrhagic Edema of Infancy

“…Also, AlSufyani suggests the male to female ratio approximately 4.64/1 (AlSufyani, 2009). However, adding the reported cases between 2008 and 2010 (Alp et al, 2009;Babic et al, 2008;Cicero, 2008;Ferraira et al, 2010;Fiore et al, 2008;Halıcıoglu et al, 2010;Jain & Patel, 2008;Javidi et al, 2008;Kumar et al, 2008;Karremann et al, 2009;Obeid et al, 2008;Slutsky et al, 2010;Sites et al, 2008) makes the male to female ratio approximately 4.34/1. Also, Fiore and colleagues reported the ratios of boys as %67 and girls as %33 in their systematic review (Fiore et al, 2008).…”

“…So, it can be suggested that AHEI can be diagnosed from newborn to 60 months of age. Actually, newly added reports of AHEI in English literature between 2008 and 2010 (Alp et al, 2009;Babic et al, 2008;Cicero, 2008;Ferraira et al, 2010;Fiore et al, 2008;Halıcıoglu et al, 2010;Jain & Patel, 2008;Javidi et al, 2008;Kumar et al, 2008;Karremann et al, 2009;Obeid et al, 2008;Slutsky et al, 2010;Sites et al, 2008) with the review by AlSufyani (AlSufyani, 2009) make the mean age approximately 16.56 months instead of 13.75 months reported by Alsufyani (Alsufyani, 2009). Indeed, there have been some reports of cases occurring beyond the age of 3 years; however, these cases have the features that overlap with those of Henoch-Schönlein purpura (Legrain et al, 1991;Shah et al, 2002).…”

“…This probably supports the role of infections and immune complexes in the pathogenesis of AHEI. Other infections described as prodromes that have been accused in the pathogenesis are upper respiratory tract infections (Alp et al, 2009;Babic et al, 2008;Blasini et al, 2007;Caksen et al, 2002;Dubin et al, 1990;Fiore et al, 2008;Gelmetti et al, 1985;Halıcıoglu et al, 2010;Ince et al, 1995;Karremann et al, 2009;Kumar et al, 2008;Lai-Cheong JE et al, 2007;McDougall et al, 2004;Michael, 2006;Millard et al, 1999;Paradisi et al, 2001;Poyrazoglu et al, 2003;Saraclar et al, 1990), pharyngitis (Gattorno et al, 1997;Gonggryp & Todd, 1998), tonsillitis (Legrain et al, 1991;Karremann et al, 2009), otitis (Caksen et al, 2002;Crowe et al, 1998;Karremann et al, 2009;Krause et al, 1996;Lantner et al, 1996;Macea et al, 2003), conjunctivitis (Legrain et al, 1991), neck abscess, bronchopneumonia (Alp et al, 2009;Saraclar et al, 1990), bronchitis (Karremann et al, 2009), pneumococcal bacteremia (Morrison et al, 1999), pulmoner tuberculosis (Gonggryp & Todd, 1998), cellulitis (Can et al, 2006), urinary tract infections (Saraclar et al, 1990) and gastroenteritis (Caksen et al, 2002;…”

“…Additionally, failure to convincingly relate AHEI to prodromal infectious caused by group A streptococcus or Mycoplasma pneumoniae is not surprising, considering that these agents mostly cause infections in children 5 years of age or older (Jaggi & Shulman, 2006;Principi & Esposito, 2002). A wide range of medications have been reported such as anti-inflammatory and/or antipyretics including ibuprofen (Blasini et al, 2007), aspirin and paracetamol (da Silva Manzoni et al, 2004;Fiore et al, 2008;Karremann et al, 2009;Legrain et al, 1991;Poyrazoglu et al, 2003;Saraclar et al, 1990), antimicrobials including penicillins (Legrain et al, 1991;Saraclar et al, 1990), amoxicillin (Blasini et al, 2007;Gattorno et al, 1997), sultamisilin (Halıcıoglu et al, 2010), erythromycin (Krause et al, 1996), tobramycin (Blasini et al, 2007), trimethoprim-sulfomethoxazol (Poyrazoglu et al, 2003), cefaleksin (Crowe et al, 1998;da Silva Manzoni et al, 2004;), ceftriaxone (Can et al, 2006), ceftibuten (Fiore et al, 2008) and other medications such as cough syrup (Dubin et al, 1990;Gonggryp & Todd, 1998) and probiotics (Fiore et al, 2008). Vaccines have also been implicated in the pathogenesis of AHEI, including diphtheriapertussis-tetanus (Krause et al, 1996;Saraclar et al, 1990), poliomavirus vaccine (Saraclar et al, 1990), hemophilus influenza conjugated (Krause et al, 1996), measles (Gonggryp & Todd, 1998;Saray et al, 2002), rubeola (Poyrazoglu et al, 2003), …”

“…This is probably because, the most papers on the subject being written different languages in the world and AHEI is called Henoch-Schönlein purpura in the United States. Although most of the prints were in case reports (Babic et al, 2008;Can et al, 2006;Di Lernia et al, 2004;Garty et al, 2002;Michael, 2006;Millard et al, 1999;Macea et al, 2003;Obeid et al, 2008;Serna et al, 1994, Silveira & Braganca, 2006, case series were also published (Alp et al, 2009;Caksen et al, 2002;Fiore et al, 2008;Gelmetti et al, 1985;Gonggryp & Todd, 1998;Ince et al, 1995;Karremann et al, 2009;Krause et al, 1996;Legrain et al, 1991;Poyrazoglu et al, 2003;Saraclar et al, 1990;Sites et al, 2008). Today, AHEI is considered as a separate entity, but not a variant of Henoch-Schönlein purpura, with clinical findings and prognosis.…”