Nodular purpura in infancy

Abstract

Summary Seventeen infants with nodular purpura are reported. All these infants suffered from a coagulation abnormality due to vitamin K deficiency. Contributing factors were breast-feeding, the use of milk substitutes, diarrhoea and antimicrobial therapy. The patients responded rapidly and completely to parenteral vitamin K. In the management of infantile diarrhoea use of antibiotics should be restricted to specific bacteriologically proven cases. Vitamin K administration is suggested in infants with prolonged gastroenteritis and limited milk intake and particularly those receiving antibiotics.

Vitamin k deficiency bleeding presenting as nodular purpura in infancy: A rare and life-threatening entity

“…[1] Anemia and leukocytosis have been reported. [358] Rapid normalization of deranged coagulation time after vitamin K administration confirms the diagnosis. [1] Coagulation time may normalize within 4 hours of vitamin K administration.…”

“…[23] Neurological signs and symptoms with/without intra-cranial hemorrhage are the most common presenting feature in 50-80% of patients. [15] Nodular purpura is not a common presenting feature.…”

“…It occurs on the lower extremities, back, chest abdomen, buttocks, upper extremities face, and neck in descending order of frequency. [34] These lesions are bluish-violet in color with raised infiltrated purplish centers, and their diameter may vary from 1.5 cm to 7.5 cm. [3] Additionally, hematomas may occur at skin puncture sites.…”

“…[1] Skin biopsy is inconclusive and showed only extravasations of RBCs without vasculitis or intravascular thrombosis in a case series. [3] Infants with VKDB should receive 5-10 mg of parenteral vitamin K1. Children with VKDB due to mal-absorption require chronic administration of high doses of oral vitamin K (2.5 mg twice/week to 5 mg/day).…”

“…Though a few case series have described the fatal intra-cranial manifestations of VKDB, very little is mentioned about its dermatological manifestations in literature. [23456] Late VKDB is an uncommon entity with incidence of 4 to 10 per 1 lakh live births and occurs mostly in exclusively breastfed infants. [1] Late VKDB is common in Southeast Asia with incidence increasing to 35 per 1 lakh live births in Thailand.…”