Acute Hemorrhagic Edema in Infants: A Continuing Clinical Challenge.

We report a case of acute hemorrhagic edema in a four-month-old boy, which occurred following a viral respiratory infection seven days prior to his admission. The clinical presentation began with the appearance of erythematous macules initially localized to both feet, which then spread to both thighs. All of this occurred against a background of a fever of 38.5 °C, while the child's general condition remained stable. Initially treated as purpura fulminans, but given the child's stable general condition and normal laboratory findings, the diagnosis was revised to acute hemorrhagic edema of infancy, characterized by fever and large, coin-shaped purpuric skin lesions, often associated with edema. The differential diagnosis includes hemorrhagic urticaria, other non-infectious vasculitides, erythema multiforme, Kawasaki disease, infectious eczema, and sepsis (meningococcal or otherwise). Some of these conditions carry a risk of mortality. Management is based primarily on symptomatic treatment, with a favorable prognosis.