Rash in a Newborn

Prenatal and Birth Histories

• Born to a 34-year-old gravida 2, para 1 Nepali woman

• Maternal history was significant for a positive purified protein derivative test and negative chest radiograph. She received treatment with isoniazid for 1 year before the pregnancy

• Prenatal history was unremarkable

• Maternal screening: Blood type B positive, syphilis nonreactive, hepatitis B surface antigen negative, human immunodeficiency virus (HIV) negative, rubella immune, group B Streptococcus negative

• Estimated gestational age: 40 weeks and 1 day

• Spontaneous vaginal delivery. A double nuchal cord was noted. Rupture of membranes at the time of delivery with clear amniotic fluid; no maternal fever

• Apgar score: 9 at 1 and 5 minutes; no resuscitation required

• Birthweight=3.021 kg (20th percentile), birth head circumference=33.5 cm (20th percentile), birth length=48.5 cm (20th percentile)

Presentation

Immediately after birth, the neonate was noted to have crusted and eroded skin lesions over the entire body. The neonate was admitted to the NICU for further evaluation of the skin lesions, concerns for possible sepsis, and isolation precautions. The infant was active and stable in room air.

Vital Signs

• Heart rate: 147 beats/min

• Respiratory rate: 59 breaths/min

• Blood pressure: 62/24 mm Hg with a mean of 37 mm Hg

• Oxygen saturation: 97%

• Temperature: 98.06°F (36.7°C)

Physical Examination

• Skin: Widespread crusted papules from scalp to feet, including palms and soles (Figs 1 and 2). The lesions were of varying size and stage. There were 2 yellow fluid-filled vesicles with erythematous bases on the lower abdomen and 2 additional large fluid-filled vesicles on the right buttock. Negative Nikolsky sign.

• Head: Anterior and posterior …