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September 2010

Acral Petechiae and Purpuric Plaques in a 3-Year-Old Girl—Diagnosis

Author Affiliations
 

MARY S.STONEMDSOONBAHRAMIMDCARRIE ANN R.CUSACKMDSENAIT W.DYSONMDMOLLY A.HINSHAWMDVINCENTLIUMD

Arch Dermatol. 2010;146(9):1037-1042. doi:10.1001/archdermatol.2010.217-b

Histologic examination of the H&E-stained specimen revealed vessels in the superficial and mid dermis infiltrated by neutrophils associated with karyorrhectic debris and fibrin characteristic of leukocytoclastic vasculitis as well as scattered eosinophils (Figure 2). Findings of DIF analysis were positive for perivascular IgA (Figure 3), fibrin, and C3. The patient was admitted to the pediatric intensive care unit, where she underwent intravenous ceftriaxone treatment for possible meningococcemia. Ceftriaxone therapy was discontinued after blood cultures proved negative. The diagnosis of AHEI was made clinically and was supported by histologic and DIF findings. After parental counseling and reassurance, the patient was discharged to home with outpatient follow-up. She recovered spontaneously without further treatment.

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