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• W2012307004 abstract "A 5-month-old girl presented to the emergency department with the acute onset of edema and large, erythematous purpuric plaques on the earlobes, which rapidly progressed to the cheeks and limbs. She had shown mild coryzal symptoms 3 days prior and low-grade fever (38°C). Her birth, developmental, and nutritional history were uncomplicated. There was no history of recent vaccination or drug intake. Physical examination revealed a well-appearing infant with multiple, coalescent, erythematous and purpuric plaques, some target-shaped, on the face and extremities, relatively sparing the trunk, with mild edema (Figure 1). The remaining physical examination was unremarkable. Urinalysis, liver and renal function testing, serum complement, immunoglobulins, clotting tests, and full blood count were normal, and C-reactive protein was negative. Skin biopsy (Figure 2; available at www.jpeds.com) and direct immunofluorescence were performed and confirmed the diagnosis of acute hemorrhagic edema of infancy. Viral serology showed evidence of acute infection by both echovirus and Coxsackie virus (IgM+, IgG−) and reverse transcription polymerase chain reaction of nasal secretions identified rhinovirus. The child received symptomatic treatment only and complete regression occurred at 4 weeks.Acute hemorrhagic edema of infancy is a rare, benign leukocytoclastic vasculitis, the differential diagnosis of which includes erythema multiforme, hemorrhagic urticaria, drug-induced vasculitis, Kawasaki disease, infected eczema, meningococcemia, and child abuse.1Fiore E. Rizzi M. Simonetti G.D. Garzoni L. Bianchetti M.G. Bettinelli A. Acute hemorrhagic edema of young children: a concise narrative review.Eur J Pediatr. 2011; 170: 1507-1511Crossref PubMed Scopus (29) Google Scholar The etiology is unknown, but there is frequent association with acute infection, recent vaccination, or drug intake.1Fiore E. Rizzi M. Simonetti G.D. Garzoni L. Bianchetti M.G. Bettinelli A. Acute hemorrhagic edema of young children: a concise narrative review.Eur J Pediatr. 2011; 170: 1507-1511Crossref PubMed Scopus (29) Google Scholar, 2Fotis L. Nikorelou S. Lariou M.S. Delis D. Stamoyannou L. Acute hemorrhagic edema of infancy: a frightening but benign disease.Clin Pediatr (Phila). 2012; 51: 391-393Crossref PubMed Scopus (13) Google Scholar, 3Jindal S.R. Kura M.M. Acute hemorrhagic edema of infancy— a rare entity.Ind Dermatol Online J. 2013; 4: 106-108Crossref PubMed Google Scholar Because there are no specific initial laboratory tests, history and physical examination provide essential clues for the successful recognition of the disease. Treatment is symptomatic and complete recovery usually occurs within 6-21 days.1Fiore E. Rizzi M. Simonetti G.D. Garzoni L. Bianchetti M.G. Bettinelli A. Acute hemorrhagic edema of young children: a concise narrative review.Eur J Pediatr. 2011; 170: 1507-1511Crossref PubMed Scopus (29) Google Scholar, 4Poyrazoglu H.M. Per H. Gunduz Z. Dusunsel R. Arslan D. Narin N. Gümüş H. Acute hemorrhagic edema of infancy.Pediatr Int. 2003; 45: 697-700Crossref PubMed Scopus (46) Google Scholar A 5-month-old girl presented to the emergency department with the acute onset of edema and large, erythematous purpuric plaques on the earlobes, which rapidly progressed to the cheeks and limbs. She had shown mild coryzal symptoms 3 days prior and low-grade fever (38°C). Her birth, developmental, and nutritional history were uncomplicated. There was no history of recent vaccination or drug intake. Physical examination revealed a well-appearing infant with multiple, coalescent, erythematous and purpuric plaques, some target-shaped, on the face and extremities, relatively sparing the trunk, with mild edema (Figure 1). The remaining physical examination was unremarkable. Urinalysis, liver and renal function testing, serum complement, immunoglobulins, clotting tests, and full blood count were normal, and C-reactive protein was negative. Skin biopsy (Figure 2; available at www.jpeds.com) and direct immunofluorescence were performed and confirmed the diagnosis of acute hemorrhagic edema of infancy. Viral serology showed evidence of acute infection by both echovirus and Coxsackie virus (IgM+, IgG−) and reverse transcription polymerase chain reaction of nasal secretions identified rhinovirus. The child received symptomatic treatment only and complete regression occurred at 4 weeks. Acute hemorrhagic edema of infancy is a rare, benign leukocytoclastic vasculitis, the differential diagnosis of which includes erythema multiforme, hemorrhagic urticaria, drug-induced vasculitis, Kawasaki disease, infected eczema, meningococcemia, and child abuse.1Fiore E. Rizzi M. Simonetti G.D. Garzoni L. Bianchetti M.G. Bettinelli A. Acute hemorrhagic edema of young children: a concise narrative review.Eur J Pediatr. 2011; 170: 1507-1511Crossref PubMed Scopus (29) Google Scholar The etiology is unknown, but there is frequent association with acute infection, recent vaccination, or drug intake.1Fiore E. Rizzi M. Simonetti G.D. Garzoni L. Bianchetti M.G. Bettinelli A. Acute hemorrhagic edema of young children: a concise narrative review.Eur J Pediatr. 2011; 170: 1507-1511Crossref PubMed Scopus (29) Google Scholar, 2Fotis L. Nikorelou S. Lariou M.S. Delis D. Stamoyannou L. Acute hemorrhagic edema of infancy: a frightening but benign disease.Clin Pediatr (Phila). 2012; 51: 391-393Crossref PubMed Scopus (13) Google Scholar, 3Jindal S.R. Kura M.M. Acute hemorrhagic edema of infancy— a rare entity.Ind Dermatol Online J. 2013; 4: 106-108Crossref PubMed Google Scholar Because there are no specific initial laboratory tests, history and physical examination provide essential clues for the successful recognition of the disease. Treatment is symptomatic and complete recovery usually occurs within 6-21 days.1Fiore E. Rizzi M. Simonetti G.D. Garzoni L. Bianchetti M.G. Bettinelli A. Acute hemorrhagic edema of young children: a concise narrative review.Eur J Pediatr. 2011; 170: 1507-1511Crossref PubMed Scopus (29) Google Scholar, 4Poyrazoglu H.M. Per H. Gunduz Z. Dusunsel R. Arslan D. Narin N. Gümüş H. Acute hemorrhagic edema of infancy.Pediatr Int. 2003; 45: 697-700Crossref PubMed Scopus (46) Google Scholar Appendix. Small for gestational age children have specific food preferencesThe Journal of PediatricsVol. 166Issue 6PreviewOliveira et al1 reported increased feeding difficulties in children born small for gestational age detected at 4-6 months of life, compared with children who were born appropriate for gestational age. Although their study did not evaluate food preferences, the authors state: “… it may be that low birth weight condition (as a proxy of in utero growth restriction) programs the appetite and satiety mechanisms, and ultimately influences the desire for specific foods”. Our group has shown that this is indeed the case. Full-Text PDF" @default.
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• W2012307004 title "Acute Hemorrhagic Edema of Infancy: A Rare Cause of Purpuric Exanthema" @default.
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