Acute hemorrhagic edema of young children: a concise narrative review

Abstract

Acute hemorrhagic edema of young children is an uncommon but likely underestimated cutaneous leukocytoclastic vasculitis. The condition typically affects infants 6-24 months of age with a history of recent respiratory illness with or without course of antibiotics. The diagnosis is made in children, mostly nontoxic in appearance, presenting with nonpruritic, large, round, red to purpuric plaques predominantly over the cheeks, ears, and extremities, with relative sparing of the trunk, often with a target-like appearance, and edema of the distal extremities, ears, and face that is mostly non-pitting, indurative, and tender. In boys, the lesions sometimes involve the scrotum and, more rarely, the penis. Fever, typically of low grade, is often present. Involvement of body systems other than skin is uncommon, and spontaneous recovery usually occurs within 6-21 days without sequelae. In this condition, laboratory tests are non-contributory: total blood cell count is often normal, although leukocytosis and thrombocytosis are sometimes found, clotting studies are normal, erythrocyte sedimentation rate and C-reactive protein test are normal or slightly elevated, complement level is normal, autoantibodies are absent, and urinalysis is usually normal. Experienced physicians rapidly consider the possible diagnosis of acute hemorrhagic edema when presented with a nontoxic young child having large targetoid purpuric lesions and indurative swelling, which is non-pitting in character, and make the diagnosis either on the basis of clinical findings alone or supported by a skin biopsy study.

Unusual Eruptions Associated with <b><i>Mycoplasma pneumoniae</i></b> Respiratory Infections: Review of the Literature

“…It is true, however, that none of the articles specifically investigated this association. A systematic review dealing with acute hemorrhagic edema of young children published a few years ago did not find any further association with infections caused by M. pneumoniae [77]. …”

“…Using the described strategy, 94 reports were retained for the final analysis [4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97]: 1 in German [23], 1 in Italian […”

Recurrent Finkelstein-Seidlmayer Disease in Four First-degree Relatives

“…Cases also exist of children who have findings overlapping between the 2 vasculitides (7). On the other hand, there are enough clinical and prognostic differences to consider FSD a distinct entity, including the different skin lesions, and especially the failure to detect depositions of immunoglobulin A in most biopsy specimens (1,8). Finally, thus far, family clusters have been exclusively reported for Henoch-Schönlein purpura (9).…”

“…This condition, which mostly affects the extremities, face and ears, presents with nonpruriginous target-like lesions, often associated with tender, non-pitting oedema (1). It affects children aged 2-60 months in an approximate male-to-female ratio of 2:1, typically does not recur, and often follows a simple febrile illness or an active immunization (1).…”

Leukocytoclastic vasculitis presenting with acute haemorrhagic oedema of the scrotum

“…Acute haemorrhagic oedema of the scrotum secondary to leukocytoclastic vasculitis was first described in 1913 by Snow and has been reported primarily in the paediatric population 4. Diagnosis is based on clinical presentation, including purpura, arthralgias and non-pitting oedema and a biopsy-proven LCV 5. Laboratory findings are generally non-contributory but may demonstrate an elevated CRP and ESR 3…”