Acute Hemorrhagic Edema of Infancy after Coronavirus Infection with Recurrent Rash

Abstract

Purpura, particularly when accompanied by fever, is a worrisome finding in children. Acute hemorrhagic edema of infancy (AHEI) is a benign type of small-vessel leukocytoclastic vasculitis that presents with progressive purpura and has an excellent prognosis. Patients with AHEI present with large, target-like purpuric plaques affecting the face, ear lobes, and extremities. While the rapid onset of these skin findings can be dramatic, the child with AHEI is usually well appearing with reassuring laboratory testing. We describe a case of a previously healthy 8-month-old female who presented with progressive purpura in a nondependent distribution, low-grade fevers, and extremity swelling. An extensive workup was performed prior to making the diagnosis of AHEI. Coronavirus was implicated as the likely triggering pathogen, and the patient suffered a recurrence of purpuric rash and swelling several weeks after her initial presentation.

Petechial Skin Rash Associated With Severe Acute Respiratory Syndrome Coronavirus 2 Infection

“…1 Other coronaviruses such as human coronavirus NL63 have been associated with purpuric eruptions, including acute hemorrhagic edema of infancy. 2 During the COVID-19 outbreak in China, dermatologic symptoms were regarded as possible comorbid conditions, drug reactions, or occupational skin diseases 3 -unrelated to SARS-CoV-2. Viral rashes can be polymorphic.…”

Acute Hemorrhagic Edema of Infancy in a 9 Months Old Child: A Case Report

“…Then it can progress to affect the face [8]. It has been noticed that less 10 % of AHEI cases have extracutaneous manifestations which include glomerulonephritis, abdominal pain, arthralgia, testicular torsion, and intussusception [10,11].…”

“…Preceding infections, vaccination and antibiotics use have been reported as triggers for AHEI [12]. Infections that are reported in literature include Rota virus induced gasteroenteritis and other viruses like herpes simplex virus, and adenovirus [8,11,13,14]. It has been found that the average period of AHEI manifestation following triggering event ranges from two days to one month [12,15].…”

“…The confirmatory test for AHEI is skin biopsy. In approximately one-third of patient biopsy shows leukocytoclastic vasculitis with IgA immunofluorescence [4,11].…”

Fever with rash in COVID‐19: viral exanthema or secondary lesions?

“…3 Other coronaviruses can cause skin symptoms, including acute haemorrhagic oedema of infancy associated with coronavirus-NL63 infection in an 8-month infant. 4 Coronavirus OC43/HKU1 was associated with Kawasaki disease 5 resulting in hyperaemia of the tongue and oral mucosa, bilateral bulbar conjunctival injection without exudate, maculopapular rash on trunk and abdomen, oedema on medial region of feet and facial pallor.…”