An 8-month-old male infant was brought with complaints of extensive reddish-purple cutaneous lesions over face (Fig. 1a), ears and lower limbs (Fig. 1b) of three days duration. There was a history of low grade fever and coryza 48-72 hours prior to the appearance of skin lesions. The baby was active, playful and feeding well. The lesions resolved spontaneously over the next two weeks, without any active intervention.

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Fig. 1 (a). Symmetrical purpuric plaques on both cheeks and (b) targetoid purpuric lesions on both lower legs in a child with acute hemorrhagic edema of infancy.

Acute hemorrhagic edema of infancy (AHEI), also called Finkelstein disease or Seidlmayer disease, is　a benign and rare cutaneous leukocytoclastic small-vessel vasculitis, characterized by palpable purpura and peripheral acral edema, seen in children aged 4 to 24 months of age.　The lesions are non-pruritic, targetoid or annular purpuric plaques or ecchymosis, symmetrically distributed over face, auricles, and extremities with sparing of the trunk and mucosal membranes. Systemic and visceral involvement usually does not occur and the child remains non-toxic. It may be triggered by infection, drugs or immunization.　The cutaneous lesions generally disappear spontaneously over 10-14 days and no specific treatment is needed. AHEI closely mimics Henoch-Schönlein purpura (HSP), which is more common in older children aged 3-6 years. Unlike AHEI, children with HSP commonly have visceral involvement, may have thrombocytopenia, and present with hematuria, acute kidney injury or arthralgia. Other differentials include erythema multiforme, erythema infectiosum, idiopathic thrombocytopenia, meningococcemia, Kawasaki disease, COVID-19, urticaria multiforme, Gianotti-Crosti syndrome, and child abuse. Since clinical presentation of AHEI is often acute and dramatic, the condition must be promptly diagnosed to avoid unnecessary investigations or hospitalization, and to reassure parents.