Infantile acute hemorrhagic edema= الوذمة النزفية الحادة عند الاطفال |
Acute HemorrhagicEdema of InfancyAHEI is a distinctive, cutaneous, small vessel leukocytoclastic vasculitis of young children with dramatic characteristic skin findings. The cutaneous findings are dramatic both in appearance and rapidity of onset. The 2 primary features include large cockade (rosette or knot of ribbons), annular, or targetoid purpuric lesions found primarily on the face, ears, and extremities, and edema of the limbs and face The typical patient with AHEI is aged 4-24 months with a history of recent upper respiratory tract illness and/or course of antibiotics. Associated fever is common but tends to be low grade, and despite the impressive clinical presentation, patients usually are nontoxic in appearance. Visceral involvement is uncommon, and spontaneous recovery usually occurs within 1-3 weeks, without sequelae. Recurrent episodes may occur Target lesions in AHEI usually are limited to limbs and the face, and progressive extremity edema occurs in AHEI that does not occur in patients with erythema multiforme .The petechiae and purpura also may resemble lesions of HSP and meningococcemia, although patients often appear much sicker with high fever, malaise, and possible shock in severe cases of meningococcemia. Most patients improve with no residual skin lesions; however, AlSufyani reported a patient with AHEI who resolved with unusual scarring Angioedema may be found in patients with HSP, but usually not in erythema multiforme or meningococcemia The duration of illness varies in patients with meningococcemia, but patients with AHEI usually are back to baseline within 2-3 weeks; patients with HSP and erythema multiforme usually are better by 4-6 weeks.
The treatment for AHEI and erythema multiforme is supportive; prednisone is controversial for HSP, and intravenous penicillin is the drug of choice for meningococcemia. PathophysiologyAcute hemorrhagic edema of infancy (AHEI) is a distinct variety of leukocytoclastic vasculitis. Leukocytoclastic vasculitis is probably mediated by immune complexes. Deposition of immunoglobulin A (IgA) is common in patients with Henoch-Schönlein purpura (HSP) but is observed in less than one third of skin biopsy specimens from patients with AHEI
ClinicalHistory
PhysicalThe clinical picture for acute hemorrhagic edema of infancy (AHEI) is quite typical.
Causes
Most cases of AHEI occur during the winter months
TreatmentMedical CareNo effective therapy exists for acute hemorrhagic edema of infancy (AHEI). Systemic steroids do not appear to alter disease course. Treatment is symptomatic; discontinue antibiotics after obtaining negative culture results. Consultations
DietAcute hemorrhagic edema of infancy (AHEI) patients usually are nontoxic in appearance. Although visceral involvement is rare, maintain a relatively bland diet with plenty of fluids to maintain hydration. ActivityNo particular restrictions in activity are required for acute hemorrhagic edema of infancy (AHEI). |