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[Scleroderma-like patch on the thigh in infants after vitamin K injection at birth: six observations]
E Bourrat1, I Moraillon, M D Vignon-Pennamen
1Service de Dermatologie, Hôpital Saint-Louis, Paris.
Insights
Texier's disease, a pseudosclerodermatous reaction, can occur in infants following vitamin K1 injections. This study reports six infant cases, highlighting the condition's presentation and potential link to the vitamin K1 injection solvent.
Area of Science:
- Pediatric Dermatology
- Dermatopathology
- Adverse Drug Reactions
Background:
- Texier's disease, a pseudosclerodermatous reaction, is typically observed in adults following intramuscular vitamin K1 injections.
- While rare, a single case report existed for newborns, prompting this investigation into a series of infant cases.
Observation:
- Six infants developed "peau d'orange" skin lesions on the medial thigh, appearing after six months of age.
- Histological examination revealed fascia and deep hypodermis lesions with inflammation and fibrosis, without visceral involvement.
- Immunological studies were consistently negative or normal in all affected infants.
Findings:
- The observed lesions in infants are consistent with Texier's disease, a stereotypic dermatosis.
- A causal link between intramuscular vitamin K1 injection at birth and the development of pseudosclerodermatous lesions is strongly suggested.
- The pathogenesis remains unclear, with potential consideration given to the solvent used in the vitamin K1 injection formulation.
Implications:
- Clinicians should consider Texier's disease when encountering pseudosclerodermatous lesions in young children, particularly those with a history of vitamin K1 injection.
- This study expands the understanding of Texier's disease in pediatric populations and its association with neonatal vitamin K1 prophylaxis.
- Further research into the specific components of injectable vitamin K1 formulations may elucidate the underlying mechanism of this adverse reaction.
Introduction:
Texier's disease or pseudosclerodermatous reaction after intramuscular injection of vitamin K1 is well known in adults although only 1 report of a case in a newborn was found in the literature. We report 6 cases.
Case Reports:
Six infants (4 boys, 2 girls) developed "peau d'orange" skin lesions after the age of 6 months which was localized in the lower third of the medial aspect of the thigh. Initial rapid locoregional extension was followed by stabilization and then regression. In all 6 cases, histology showed lesions of the fascia and/or the deep hypoderma associated with variable mononuclear inflammatory infiltration and hyalin fibrosis. When performed, immunological studies (complement fixation, search for autoantibodies) were always negative or normal. No visceral involvement was found.
Discussion:
A pseudosclerodermatous lesion of the lower third of the thigh occurred in 6 infants at the site of an intramuscular injection of vitamin K1 administered at birth. The history, clinical manifestations, histology and outcome of these cases are compatible with the diagnosis of Texier's disease. We discuss the role of the solvent in the Roche vitamin K1 injection. The pathogenesis of this side effect remains unknown.
Conclusion:
Texier's disease in infants after injection of vitamin K1 at birth is a stereotypic dermatosis. Diagnosis is based on history and clinical presentation. The causal effect of injectable vitamin K1 should be entertained whenever pseudosclerodermatous lesions are observed in a young child.