Acute hemorrhagic edema of infancy: a worrisome presentation, but benign course
A 14 month old boy presented to our emergency department with intermittent low grade fever of 2 days duration associated with a rash, swelling of the left leg, and an inability to bear weight. The mother stated that the patient had a runny nose and a mild cough 1 week prior to admission.\nThere was no diarrhea, change in behavior, toxic ingestion, medication use, or any recent vaccinations. Past medical history and family history were unremarkable and immunizations were up to date. The patient was admitted to the ward for fever and rash. On admission, his temperature was 38°C, he had a respiratory rate of 25 breaths per minute, his heart rate was 110 beats per minute, and his blood pressure was 100/70 mmHg.\nOn examination, the patient was not looking toxic, his neck was supple, and the neurological exam was unremarkable. The skin showed ecchymotic, purpuric, targetoid plaques with oval and round shapes on the face and extremities (–). The right auricle of the ear was mildly edematous and purple in color. There was mild swelling on the hands and lower extremities without skin induration and the range of motion of all joints was normal. The rest of the physical exam was unremarkable. The complete blood count and urine analysis were both unremarkable.\nA decision was made to biopsy one of the lesions from the left forearm and it showed inflammatory infiltrate surrounding dermal blood vessels. The infiltrate was a mixture of neutrophils, lymphocytes, and scattered eosinophils with fragmented nuclei of neutrophils, and there was focal necrosis of the vessel wall. On direct immunofluorescence there was no immunoglobulin A (IgA) deposition. The patient was discharged after the diagnosis and the rash resolved spontaneously in 3 weeks.