Parental Anxiety to Unexplained Bruising: A Case Report of Acquired Platelet Dysfunction with Eosinophilia (original) (raw)

Acquired platelet dysfunction with eosinophilia mimicks non-accidental injury: a case report

2019

Acquired platelet dysfunction with eosinophilia (APDE) is a syndrome which has transient state of platelet dysfunction in the presence of marked eosinophilia. This bleeding disorder, otherwise known as ''non-thrombocytopenic purpura with eosinophilia'', occurs commonly in children from SouthEast Asia. We report an 11 years old male child, who presented with ecchymotic patches over lower limbs, of recent onset. His hemogram revealed increased eosinophils with a normal platelet count. Coagulation screen revealed normal parameters except increase in bleeding time. Platelet aggregation studies showed normal platelet aggregation with ristocetin, reduced aggregation with ADP and no aggregation was seen with collagen.

Thrombocytopathic purpura associated with eosinophilia

Transactions of the Royal Society of Tropical Medicine and Hygiene, 1984

An acquired bleeding syndrome associated with eosinophilia occurs in Southeast Asia, mainly in children. Bleeding is known to result from impaired platelet function. This paper reports seven previously healthy young adults from Singapore who exhibited this syndrome. Bleeding was confined mainly to the skin and mucosal surfaces; no unusual clinical findings were noted. The bleeding tendency was transient. Intestinal helminths were found in four cases; five were mildly thrombocytopenic at onset. Platelet aggregation abnormalities were transient and the pattern suggested storage pool disease; this is discussed in relation to recent studies of the syndrome. The possible pathogenic role of eosinophilia and parasitism is also discussed.

Platelet dysfunction-eosinophilia syndrome in parasitized Venezuelan children

The American Journal of Tropical Medicine and Hygiene, 2005

Platelet dysfunction was detected in six children with purpura and eosinophilia. We conducted clinical evaluations, hematologic and platelet function tests, clotting studies (bleeding time, prothrombin time, partial thromboplastin time, thrombin time, factor XIII, factor VIII, and von Willebrand factor), assays for IgG and IgM antibodies to platelets, and a search for stool parasites. Mild bleeding phenomena (ecchymoses, petechiae, epistaxis, and gingival) were transient. All children showed intestinal parasites and marked eosinophilia (mean count ‫ס‬ 2,615.2 cells/L, 95% confidence interval ‫ס‬ 1,259.6-5,429.8). Main abnormalities included prolonged bleeding times (50%) and defective aggregation with collagen (100%) adrenaline (66%), or ADP (66%). Antibodies to platelets were not detected. Antiparasite therapy reversed the hemorrhagic manifestations and normalized eosinophil counts and platelet alterations. No relationship could be established between excess eosinophils, intensity of bleeding, or type and degree of platelet abnormalities. Thrombocytopathic features mimicked the intrinsic defect of storage pool disease. The possible pathogenic roles of eosinophilia and parasitism are reviewed. This is the first report of this pathologic combination in Latin American children.

Infantile Acute Hemorrhagic Edema: Four Attacks in Two Years

Abant Medical Journal, 2015

İnfantil akut hemorajik ödem (İAHÖ), ani başlangıç ve ekimotik purpura ile karakterize hedef ve rozet şeklinde inflamatuar ödemle seyreden benign bir hastalıktır. Genellikle 2 yaşın altındaki çocuklarda görülür ve neredeyse hiç rekürrens gözlenmez. Bu hastalık kutanöz vaskülitin nadir bir formu olarak düşünülür. Burada biz kliniğimize başvuran ve İAHÖ tanısı alan bir kız çocuğunu bildirdik. Döküntü ilk kez 2 yaşın altında başlamış ve 2 yıl içerisinde 6 ay arlıklarla 4 kez tekrar etmiş. Literatürde relaps çok nadir olarak bildirilmiştir, biz bu vakayı hastanın 2 yaşının üzerine olması ve toplamda 4 atak geçirmesi üzerine seçtik. Infantile acute hemorrhagic edema (IAHE) is a benign disease which is characterized by target and rosette-shaped inflammatory edema which has a dramatic beginning and characterized by ecchymotic purpura. It is generally seen in infants under 2 years of age and recurrence is hardly observed. It is thought that this disease is a rare form of cutaneous vasculitis. Here we reported a 4-year-old girl who applied to our clinic and was diagnosed IAHE. Serpigo first started at the age of 2 and repeated 4 times in 2 years with 6-month intervals. As the relapse was seldom reported in the literature, we chose to report this case owing to the fact that the patient was over 2 years old and had 4 attacks in total.

Acute hemorrhagic edema of infancy

Archives of Iranian …, 2008

Acute hemorrhagic edema of infancy is a rare form of leukocytoclastic vasculitis. Mostly it appears under three years of age and is characterized by purpuric skin lesions, fever and edema. A three years-old boy, who has cough and coryzea was admitted to our clinic for fever and red spots on legs and arms. In physical examination; ecimotic skin lesions on right ear, face, arms, dorsal of the hands, buttocks, legs and dorsal of the feet were found. In the laboratory tests acute phase reactants were elevated and blood coagulation tests were in normal range. Hepatit A,B,C and TORCH markers were negative. Punch biopsy obtained from gluteal area showed leukositoclastic vasculity. Focal fibrinogen accumulation was detected by immun fluorescent microscopy. Regression on lesions was not observed despite supportive therapy, so prednisolone (1 mg/kg/day) therapy was started. On the third day of the steroid therapy, complete recovery was achived.

Acute hemorrhagic edema of young children: a concise narrative review

European Journal of Pediatrics, 2011

Acute hemorrhagic edema of young children is an uncommon but likely underestimated cutaneous leukocytoclastic vasculitis. The condition typically affects infants 6-24 months of age with a history of recent respiratory illness with or without course of antibiotics. The diagnosis is made in children, mostly nontoxic in appearance, presenting with nonpruritic, large, round, red to purpuric plaques predominantly over the cheeks, ears, and extremities, with relative sparing of the trunk, often with a targetlike appearance, and edema of the distal extremities, ears, and face that is mostly non-pitting, indurative, and tender. In boys, the lesions sometimes involve the scrotum and, more rarely, the penis. Fever, typically of low grade, is often present. Involvement of body systems other than skin is uncommon, and spontaneous recovery usually occurs within 6-21 days without sequelae. In this condition, laboratory tests are non-contributory: total blood cell count is often normal, although leukocytosis and thrombocytosis are sometimes found, clotting studies are normal, erythrocyte sedimentation rate and C-reactive protein test are normal or slightly elevated, complement level is normal, autoantibodies are absent, and urinalysis is usually normal. Experienced physicians rapidly consider the possible diagnosis of acute hemorrhagic edema when presented with a nontoxic young child having large targetoid purpuric lesions and indurative swelling, which is non-pitting in character, and make the diagnosis either on the basis of clinical findings alone or supported by a skin biopsy study.

On target: a case of acute hemorrhagic edema of infancy

Hospital pediatrics, 2014

VOLUME 4 • ISSUE 2 www.hospitalpediatrics.org EIA is a recurring section of Hospital Pediatrics where expert pediatric hospitalists give their interpretation of the recent evidence in reference to common clinical questions encountered in their daily practice.