Human Metapneumovirus Associated With Acute Hemorrhagic Oedema of Infancy: A Case Report

Acute Haemorrhagic Oedema of Infancy (AHOI), also known as Acute Hemorrhagic Edema of Infancy (AHEI), is characterized by purpuric skin lesions, edema, and fever. It is classified as a form of cutaneous leukocytoclastic vasculitis. Clinically, AHOI presents with targetoid, purplish spots on the face and limbs, accompanied by the sudden onset of peripheral edema. AHOI is often associated with infections, including rotavirus, cytomegalovirus (CMV), and pneumococcal bacteremia. In this case, an eight-year-old male infant presented to the emergency room with fever, cough, and a newly developed, non-blanching red macular rash that spread across his face, neck, chest, abdomen, back, and legs, gradually increasing in size over the course of illness. A complete blood count revealed neutrophilia with a normal leukocyte count, and C-reactive protein levels were elevated at 70 mg/L. Human metapneumovirus (hMPV) was detected in a nasopharyngeal aspirate. Abdominal ultrasound showed moderate splenomegaly and enterocolitis. This case highlights a rare association between AHOI and hMPV infection, contributing to the understanding of hMPV as a potential infectious trigger in AHOI pathophysiology.