A Newborn with “Black Spots”

Qiyun Shi; Sravanti Kurada

doi:10.1542/neo.20-8-e482

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.

Download PDF

The Case

A newborn presents with “black spots” all over the body.

Prenatal and Birth Histories

Born to a 20-year-old gravida 2 para 1 black woman with a history of 1 spontaneous miscarriage
Prenatal course unremarkable; normal prenatal fetal survey
Estimated gestational age: 38 6/7 weeks
Cesarean section due to failure of progression of labor
Prenatal maternal laboratory findings: HIV negative, hepatitis surface antigen negative, nontreponemal screening negative, and rubella immune; group B Streptococcus screening positive at 38 weeks’ gestation
Intrapartum fever with temperature recorded at 101.3°F (38.5°C); vancomycin administered 6 hours before delivery because of a documented maternal allergy to penicillin
Apgar scores: 9 and 9 at 1 and 5 minutes, respectively

Presentation

The infant was admitted to the NICU for evaluation of possible infection because of suspected maternal chorioamnionitis. On physical examination, the infant was active. The infant had more than 20 brown and black macules and patches on the trunk and the lower extremities (Figs 1 and 2). An 11-cm sharply circumscribed brownish black plaque with verrucous texture and no visible hair follicles was noted and involved the entire left side of the scalp, sparing the occipital region (Fig 3).

Figure 1.

Multiple hyperpigmented lesions on the back.

Figure 2.

Multiple hyperpigmented lesions on the lateral of thigh.

Figure 3.

A large brownish black plaque on the scalp.

The mother’s medical history was significant for 20 nonmalignant black macules and patches on her back, mainly in the interscapular region. The infant’s maternal grandmother reported similar skin lesions over her body, with dense distribution on the lower extremities.