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A Case of Human Metapneumovirus Associated with Acute Haemorrhagic Oedema of Infancy

Acute Haemorrhagic oedema of infancy (AHOI) is a cutaneous leukocytoclastic vasculitis, clinically characterized by the acute development of peripheral oedema and targetoid purpuric lesions on the face and extremities [1]. It is commonly associated with Pneumococcal Bacteremia [2], CMV infection [1] and Rotavirus infection [3]. There was a 12-year-old boy who presented to the Emergency department with 2 days history of widespread non-blanching, erythematous, macular rash distributed over his face, chest, abdomen, back and legs; which was noted to gradually increase in size over the course of his illness. Aside from this, he had also experienced coryzal symptoms and mild temperatures. All other blood tests were within normal parameters. A nasopharyngeal aspirate was collected and found to be positive for Human Metapneumovirus. To our knowledge, this is the first reported case of AHOI associated with hMPV. pruritis or tenderness was apparent. Furthermore, no target lesions, pustules or nodules were evident and the mucous membranes appeared to be spared. Oedema involving both ankles to the knee, was striking and proved to be painful with the child not weight bearing throughout the course of the illness. The remainder of his systemic examination was unremarkable. The rash and oedema were noted to be clinically consistent with Acute Haemorrhagic Oedema of Infancy (AHOI). A full blood count together with coagulation profile, c reactive protein, liver function tests and iron studies were requested which revealed microcytic, hypochromatic erythrocytes and a low ferritin consistent with iron deficiency anaemia. All other blood tests were within normal parameters. A nasopharyngeal aspirate was collected and found to be positive for Human Metapneumovirus. Over the course of the next two days, the rash was noted to fade rapidly together with a marked reduction in lower limb oedema. Antihistamines and Non-steroidal anti-inflammatories were used to manage his discomfort.