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ISSN: 1642-395X
Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii
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vol. 39
Letter to the Editor

Daily follow-up of a scary onset of ecchymotic purpuric lesions in an infant

Maher Al-Muriesh
1, 2
Juan Liu
3, 4
Hongxia Du
Shidi Wu
Ting Wu
Yanhong Sun
Changzheng Huang

Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
Department of Dermatology, 21 September University of Medicine and Applied Sciences, Sana'a, Republic of Yemen
Paediatric Department, Xinyang Central Hospital, Xinyang, China
Shenzhen Longhua Maternity and Child Healthcare Hospital, Shenzhen, China
Department of Dermatology, Xinyang Central Hospital, Xinyang, China
Department of Dermatology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
Adv Dermatol Allergol 2022; XXXIX (4): 806-808
Online publish date: 2022/09/01
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An 8-month-old boy was admitted to the hospital with purpuric rash and oedematous ears appearing 1 day before his visit. The patient had a mild cough, nose discharge with no sputum, and fever preceding the onset of the rash. The rash began as oedema emerging from the auricles of both ears (Figures 1 A, B). On days 2–4 following the onset of the rash, lesions developed and gradually involved the patient’s cheeks, thighs, and limbs; they eventually became tender purplish-red plaques (Figures 1 C–H). On the fifth day following the onset of symptoms, the child’s oedema began to resolve and the lesions gradually faded (Figures 1 I–K). The lesions finally resolved with central crusting on the eighth day after symptoms first developed (Figure 1 I, L).
On physical examination, the child’s general condition was good; his pharynx was slightly red, and the heart and lung showed no auscultation abnormalities. Skin examination showed symmetrically distributed rosette-like purpuric petechiae and ecchymosis localized on both cheeks, ears, buttocks, and limbs with prominent oedema and tenderness. Some plaques showed a cockade pattern, and other plaques coalesced to form large purpuric lesions with polycyclic borders. Severe non pitting oedema was noted on the patient’s face and limbs. No signs of mucosal or systemic involvement were found.
Laboratory examination at the time of admission revealed the following: white blood cells, 14.82 × 109/l (3.5–9.5 × 109/l); platelets, 621 × 109/l (125–350 × 109/l); red blood cells, 4.67 × 109/l (4–4.5 × 109/l); haemoglobin, 76 g/l (110–120 g/l); C-reactive protein, 36.20 mg/l (0–5 mg/l); D-dimer, 12.54 mg/l (0–0.5 mg/l); FDP, 36.36 µg/l (0–5 µg/l); ESR, 48 mm/h (0–15 mm/h); ferritin, 17.90 ng/ml (23.9–336.2 ng/ml); and vitamin B12, 165.81 ng/ml (180–914 pg/ml). Tests for liver function, myocardial enzymes, rheumatoid factor, autoantibodies, and urine analysis yielded normal findings. Ultrasound of the liver, gallbladder, pancreas, and spleen showed no abnormalities. Chest radiographs showed an increase in bilateral texture and cloudiness. Imaging revealed bronchial pneumonia. A biopsy of the lesions indicated features of leukocytoclastic vasculitis. At the time of admission, the following diagnoses were initially made: 1. skin infection, and 2. allergic purpura. Ceftriaxone and methylprednisolone were administered for 4 days and then discontinued after the diagnosis of acute haemorrhagic oedema of infancy (AHEI) was...

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