This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
The Case
A female term newborn presents with a generalized rash with eroded and crusted skin lesions.
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.
Case Progression
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 …
Individual Login
Institutional Login
You may be able to gain access using your login credentials for your institution. Contact your librarian or administrator if you do not have a username and password.