Acute Hemorrhagic Edema of Infancy: A Case Report

Abstract

Acute hemorrhagic edema of infancy is a rare vasculitic syndrome affecting young children. Although presentation is dramatic and striking, it is a benign disorder. A 9-month-old boy with fever, rhinorrhea, edema, and purpuric lesions involving the face, oral mucosa, ears, and extremities was presented.

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).…”

“…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 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, Fiore and colleagues reviewed that purpura had a relative frequency on the left side of the body (Fiore et al, 2008). Skin or mucous membranes are uncommonly involved in AHEI such as conjunctiva (McDougall et al, 2004;Poyrazoglu et al, 2003), buccal mucosa (Halıcıoglu et al, 2010;Roh et al, 2004), palate (Blasini et al, 2007;Chatproedprai & Wananukul, 2007;Gelmetti et al, 1985;Poyrazoglu et al, 2003), gums (Di Lernia et al, 2004), uvula, tongue, pharynx (Amitai et al, 1993;Di Lernia et al, 2004;Dubin et al, 1990;Krause et al, 1996;McDougall et al, 2005), calf (Fiore et al, 2008;Poyrazoglu et al, 2003), scrotum (Dubin et al, 1990;Karreman et al, 2009;Poyrazoglu et al, 2003), buttocks (Amitai et al, 1993;da Silva Monzani et al, 2004;Legrain et al, 1991;Michael, 2006;Paradisi et al, 2001;Roh et al, 2004;Saraclar et al, 1990;Serna et al, 1994;Shah et al, 2002), joints (AlSheyyab et al, 1995;Gattorno et al, 1997) and perineum (Lantner & Simon, 1996). Extracutaneous manifestations rarely occur; however, renal involvement with microscopic hematuria, proteinuria and hypocomplementemia (Watanabe & Sato, 2007); transient and microscopic hematuria (Al-Sheyyab et al, 1995;Amitai et al, 1993;Gonggryp & Todd, 1998;…”

“…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).…”