Case of the month: a girl with oedema and purpuric eruption

Abstract

Abbreviations AHEI acute haemorrhagic oedema of infancy á SHP SchoÈ nlein-Henoch purpura Information A 23-month-old girl was evaluated because of oedema and purpuric eruption on the upper trunk and the lower extremities, 15 days after an upper respiratory tract infection, treated with antibiotics (azitrocin). On the following days, erythematous macular skin lesions appeared over the auricles, hands, arms, feet and perineal and gluteal regions.Physical examination on admission revealed an otherwise healthy and afebrile child. Multiple purpuric, oedematous, target-like plaques were present mainly on the face, auricles, lower extremities ( Fig. 1) and upper trunk.The following laboratory tests were within the normal range: haemoglobin levels, platelet number, coagulation pro®le, blood urea, creatinine, liver enzymes, serum levels of IgG, IgA and IgM, C 3 , C 4 , antistreptolysin O titre, anti-nuclear and anti-DNA antibodies, and urinalysis. Stool examination and throat culture were negative. White blood cell count revealed 22,000/mm 3 leucocytes (with 76% neutrophils) and the erythrocyte sedimentation rate was elevated at 22 mm/h. Circulating immune complexes were positive.All cutaneous lesions regressed spontaneously without any speci®c treatment within 3 weeks. Up to now, after 2-year follow up there is no recurrence.

Acute haemorrhagic oedema of infancy in a 5‐week‐old boy referred to the Child Protection Unit

“…The largest case series and systematic review of AHO, published in 2008, reviewed 294 children from single case reports or case series published between 1913 and 2008 and reported the age range of affected children as 2–60 months . Our case highlights that this disorder can affect children younger than 2 months of age, and there is one report of a case in a neonate …”

Edema agudo hemorrágico da infância

“…A incidência aumenta nos meses de inverno juntamente com as infecções das vias aéreas superiores, que na maioria das vezes precedem o aparecimento das lesões. O uso de medicamentos e/ou imunização também são fatores precipitantes (1)(2)(3)(4)(5) .…”

“…Alguns autores defendem tratar-se de uma variante da púrpura de Henoch-Schonlein (PHS), sendo a distribuição das lesões dependente da gravidade (localizadas em tronco e face nos lactentes e membros inferiores nos pré-escolares e escolares) (3) . Entretanto, existem diferenças importantes entre as duas patologias (2) .…”

“…Outros importantes diagnósticos diferenciais do EAHI: lúpus neonatal, meningococcemia, síndrome de Sweet, eritema multiforme, doença de Gianotti e doença de Kawasaki (2,3,4,7) .…”

“…Inicialmente foi melhor reconhecida pela literatura européia. Acredita-se que exista subdiagnóstico e muitos autores defendem tratar-se de um tipo de manifestação da púrpura de Henoch-Schonlein em lactentes (1)(2)(3) .…”