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Question: fever + rash

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You are seeing a 10 month old infant with one day of fever, purpuric rash, and subcutaneous edema of bilateral extremities. He was seen in the ED one week ago for cough and congestion and diagnosed with a viral URI. At that time, COVID, influenza, and RSV were negative. On exam, his temp is 39.1. He has multiple, scattered, annular, sharply demarcated hemorrhagic plaques, mainly on his cheeks and bilateral extremities, lower > upper. He is otherwise well appearing and remainder of the physical exam is unremarkable. CBC including platelet count, CMP, coags, DIC panel, CRP, UA, and CSF were all normal.

What is the most likely diagnosis?

pemsou5_wp • April 19, 2022

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  1. Kelly April 26, 2022 - 8:00 pm Reply

    B) Acute hemorrhagic edema of infancy
    AHEI is a benign vasculitis, thought possibly to be a milder cutaneous version of Henoch Schonlein Purpura. Patients are typically 4-24 months of age, and while the presentation is impressive due to the non-blanching rash, edema, and commonly fever, the disease typically spontaneously resolves in 1-3 weeks. The child is very well appearing and without abnormal labs, purpura fulminans is unlikely. Fever has only been for one day, and no other findings for Kawasaki besides rash and edema are described. NAT is unlikely without description of other risk factors and injuries, and would not explain the fever. MIS-C is unlikely as the COVID was negative, labs were normal, and there were no other Kawasaki-like findings on exam.

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