TWO PEDIATRIC CASES OF URTICARIA MULTIFORME
Keywords:
Urticaria multiforme, Acral edema, Ecchymotic hue, Prurit, Corticosteroid, Antihistamine.Abstract
Urticaria multiforme is a morphological subtype of acute urticaria, often mistaken for erythema multiforme, serum sickness, or cutaneous vasculitis. Synonyms include acute annular urticaria, acute urticarial hypersensitivity syndrome, echymotic urticaria, and urticaria hemorrhagica. Diagnostic criteria are typical annular and polycyclic urticaria, echymotic changes, pruritus, acral edema, and absence of target lesions, necrosis, or bullous changes. Echymotic changes last 24-48 hours, with rapid response to antihistamines and corticosteroids. It typically affects children aged 4 months to 4 years. We describe two pediatric cases with typical clinical and laboratory features of urticaria multiforme.
A 3-year-old boy was admitted with migratory, erythematous, pruritic wheals that appeared on the fourth day of fever, following antipyretic treatment. No prior medical history or recent vaccinations. By day 2, peripheral edema and diffuse erythema developed. Between days 3-5, polycyclic, ecchymotic wheals appeared along with new itchy lesions. An otherwise healthy 11-month-old girl was hospitalized with erythematous, pruritic wheals and annular, urticaroid, erythema multiforme-like lesions. Symptoms began on day 2 after a 7-day course of antibiotics for an upper respiratory infection. No prior medical history, allergies, or recent vaccinations. After corticosteroid and antihistamine treatment, the lesions resolved completely by over the course of one week in both cases.
References
Tamayo Sánchez L, Ruiz Maldonado R, Laterza A. Acute annular urticaria in infants and children. Pediatr Dermatol. 1997;14(3):231–234. doi:10.1111/j.1525-1470.1997.tb00246.x
Shah KN, Honig PJ, Yan AC. Urticaria multiforme: a case series and review of acute annular urticarial hypersensitivity syndromes in children. Pediatrics. 2007;119(5):e1177–e1183. doi:10.1542/peds.2006-1553
Sempau L, Martín Sáez E, Gutiérrez Rodríguez C, Gutiérrez Ortega MC. Urticaria multiforme: a report of 5 cases and review of the literature. Actas Dermosifiliogr. 2016;107(1):e1–e5. doi:10.1016/j.ad.2015.01.003
Fung IN, Berger EM, Castelo Soccio L, Brown Whitehorn TF. Urticaria multiforme in an 18 year old girl. J Allergy Clin Immunol Pract. 2013 Sep Oct;1(5):520–521. doi:10.1016/j.jaip.2013.06.009
Legrain V, Taieb A, Sage T, Maleville J. Urticaria in infants: a study of forty patients. Pediatr Dermatol. 1990;7(2):101–107. doi:10.1111/j.1525-1470.1990.tb00663.x
Mortureux P, Léauté Labrèze C, Legrain Lifermann V, Lamireau T, Sarlangue J, Taïeb A. Acute urticaria in infancy and early childhood: a prospective study. Arch Dermatol. 1998;134(3):319–323. doi:10.1001/archderm.134.3.319
Emer JJ, Bernardo SG, Kovalerchik O, Ahmad M. Urticaria multiforme. J Clin Aesthet Dermatol. 2013 Mar;6(3):34–39. PMCID: PMC 3613272
Novembre E, Cianferoni A, Mori F, et al. Urticaria and urticaria related skin condition/disease in children. Eur Ann Allergy Clin Immunol. 2008;40(1):5–13.
Toledo Alberola F, Betlloch Mas I. Annular erythema of infancy. Actas Dermosifiliogr. 2010;101(6):473–484. doi:10.1016/S1578-2190(10)70832-5
Mathur AN, Mathes EF. Urticaria mimickers in children. Dermatol Ther. 2013;26:467–475.
Guerrier G, Daronat J, Deltour R. Unusual presentation of acute annular urticaria: a case report. Case Rep Dermatol Med. 2011;2011:604390. doi:10.1155/2011/604390
