Acute hemorrhagic edema of infancy-a rare entity
An 18 month-old girl was referred from the paediatric department for purpuric skin lesions since 3 days. She had an upper respiratory infection 5 days prior to the development of the skin lesions. Her mother reported seeing reddish colored spots initially on the legs which gradually increased to involve the face, legs and arms. There was no recent history of vaccination or any drug intake. On general examination the child was irritable and mildly febrile. The cutaneous examination showed many symmetrically distributed, round and oval, ecchymotic, purpuric, targetoid plaques localized on the cheeks and extremities, in particular lower limbs. The ears appeared oedematous []. Soles showed violaceous targetoid macules []. Some plaques showed a cockade pattern [], while others coalesced to form large purpuric lesions with polycyclic borders. Moderate non-pitting edema was noted over her hands and feet []. There was no mucosal involvement. The remainder of the physical examination was unremarkable and there were no signs of systemic involvement. Urinalysis, liver and renal function test, and complete blood count were within normal limits. Stool was negative for occult blood. Erythrocyte sedimentation rate was elevated. Histopathological examination of cutaneous lesion showed features of leucocytoclastic vasculitis []. The skin lesions, as well as fever resolved without treatment within two weeks.