Acute hemorrhagic edema of infancy (AHEI), also known as acute hemorrhagic edema of childhood or postinfectious cockade purpura, is a leukocytoclastic vasculitis affecting children aged 4 months to 2 years. It is characterized by edematous hemorrhagic lesions of the head and distal extremities and is usually noted after an upper respiratory tract infection and/or a course of antibiotics. AHEI following COVID-19 infection has been reported.
Although the cause is unknown, it is thought to be an immune complex-related reaction to infection, drugs, or vaccination. Some consider it to be a variant of immunoglobulin A vasculitis (IgAV, formerly Henoch-Schönlein purpura); there are cases of children aged 2-4 years who have symptoms overlapping AHEI and IgAV.
AHEI is uncommon but reported worldwide. Most cases occur in winter.
Edema of the face is often seen initially, suddenly followed by skin lesions beginning distally and spreading proximally. The patient may have a low-grade fever but does not appear toxic. Systemic symptoms are rare, although joint, gastrointestinal (with bloody diarrhea), and renal (with hematuria and proteinuria) involvement may occur. Purpuric lesions can be painful.
Illness lasts 1-3 weeks and resolves without consequence. Recurrences may occur.
Acute hemorrhagic edema of infancy
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Synopsis
Codes
ICD10CM:
D69.0 – Allergic purpura
P83.39 – Other edema specific to newborn
SNOMEDCT:
402856005 – Acute hemorrhagic edema of childhood
D69.0 – Allergic purpura
P83.39 – Other edema specific to newborn
SNOMEDCT:
402856005 – Acute hemorrhagic edema of childhood
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Differential Diagnosis & Pitfalls
- IgAV – Typically presents with more systemic involvement (with abdominal pain, arthritis, and nephritis).
- Erythema multiforme minor – Target lesions in AHEI are usually limited to the limbs and face, and progressive extremity edema that occurs in AHEI does not occur in patients with erythema multiforme.
- Acute meningococcemia – Patients often appear much sicker, with high fever, malaise, and possible shock.
- Kawasaki disease
- Child abuse
- Autoinflammatory disease – See, eg, TNF receptor-associated periodic syndrome (TRAPS), cryopyrin-associated periodic syndromes, and CANDLE syndrome, among others.
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Last Reviewed:02/12/2022
Last Updated:02/13/2022
Last Updated:02/13/2022
Acute hemorrhagic edema of infancy