Vitamin K Deficiency Bleeding Presenting as Nodular Purpura in Infancy: A Rare and Life-Threatening Entity
An 8-month-old exclusively breastfed male infant presented in casualty with multiple skincolored to bluish, raised swellings on trunk and upper extremities of 4 days duration. This was associated with malena for last 2 days. There was no history of fever, excessive cry, jaundice, bleeding diathesis, vomiting, breathlessness, or any drug intake in recent past. The lesions were acute in onset and progressive in nature. The infant was a product of non-consanguineous marriage and was born at term in a primary health center. There were no perinatal complications. History of vitamin K prophylaxis at birth was not forthcoming. There were two elder healthy male siblings. Mother denied any history of drug intake recently by infant or herself. Cutaneous examination revealed multiple firm to soft, non-collapsible, subcutaneous, non-tender, skin colored to bluish nodules of 1-6.5 cm in diameter on the chest, elbow, and knees [Figures and ]. General examination revealed a grade III malnourished child (as per classification of Indian Academy of Pediatrics) with normal developmental milestones. General and systemic examination failed to reveal any abnormality, except pallor. Investigations revealed raised APTT and PT levels along with microcytic, hypochromic anemia. Fibrinogen level, platelet count, routine urine microscopy, and other hematological and biochemical parameters were within normal range. Blood culture was sterile, and skin biopsy was not performed as FNAC from a large purpuric nodule revealed frank blood. Vitamin K level estimation could not be done due to financial constraints.\nA provisional diagnosis of late idiopathic vitamin K deficiency bleeding (VKDB) disorder was made, and the child was given 7.5 mg vitamin K1 intra-muscularly once-daily for 3 days. The infant improved dramatically. Prolonged APTT and PT normalized within 10 hours of first dose. All the lesions subsided by 6th day. The infant was put on proper complementary feeding, and no recurrence was noted during follow-up even 6 months after the initial episode.