On Target: A Case of Acute Hemorrhagic Edema of Infancy

[摘要] Case: A 16-month-old female presented to a referring emergency department with a 2-day history of a progressive rash and swelling that started on her right lower extremity and spread to her upper extremities, trunk, and face (Fig 1). The patient had recently been hospitalized at the referring hospital for bronchiolitis caused by respiratory syncytial virus and was being treated with amoxicillin for otitis media. Her mother had stopped the antibiotic 1 day before presentation after development of a rash and had given the patient diphenhydramine, with no improvement. The patient had a fever with the preceding illness but on admission to the emergency department was afebrile. She had received hepatitis B and diphtheria-tetanus-acellular pertussis vaccines at her 15-month well-child examination 3 weeks before the onset of the rash. The patient had 1 day of decreased oral intake and decreased urine output and a 2-day history of loose stools. Family history is significant for multiple maternal family members with reaction to penicillin causing hives and edema. At the referring hospital, intraosseous (IO) access was obtained after multiple attempts to place intravascular access were unsuccessful, secondary to diffuse body edema. In our emergency department, the medical team attempted to obtain intravascular access with ultrasound guidance; however, they were also unsuccessful because of the patient’s persistent edema. The patient received normal saline via the IO line in addition to oral acetaminophen and diphenhydramine.FIGURE 1 A 16-month-old female with rash and swelling.Physical examination revealed a fussy but consolable, well-nourished toddler with diffuse body edema, scratching at her arms and thighs. She was afebrile, tachycardic to 134 beats per minute, and hypertensive to 126/97 mm Hg. Erythematous annular lesions surrounded the patient's …

[学科分类] 儿科学

[关键词] Campylobacter;proljev;dob