Case 1: Fever, Rash, and Hyperleukocytosis in a Newborn

Abstract

An infant is born at 38 weeks and 5 days’ gestation via spontaneous vaginal delivery to a 22-year-old, gravida 2, para 1-0-1-1 woman. This pregnancy is complicated by preeclampsia and chorioamnionitis, and the mother is given magnesium sulfate, ampicillin, and gentamicin intrapartum. The mother has negative serologic findings for human immunodeficiency virus, hepatitis B, and syphilis. She is rubella immune and negative for group B Streptococcus . Membranes have been ruptured for 14 hours at the time of delivery. The neonate requires stimulation and oral suctioning at birth and has an Apgar score of 8 at 1 and 5 minutes. Immediately after birth, the neonate has a temperature of 102.9°F (39.3°C) and a diffuse nonblanching macular blue-purple rash. The neonate is admitted directly to the level 2 NICU. Initial laboratory findings include a white blood cell (WBC) count of 167,200/μL (167.2×109/L; 2% neutrophils, 1% basophils, 11% lymphocytes, 4% monocytes, and 82% blasts), hemoglobin of 18.3 g/dL (183 g/L), and platelet count of 142×103/μL (142×109/L). The aspartate transaminase level is 118 IU/L (1.9 μkat/L) and alanine transaminase level is 33 IU/L (0.5 μkat/L). Prothrombin time is 31.7 seconds, partial thromboplastin time is 52.5 seconds, and fibrinogen is 116 mg/dL (3.4 μmol/L). With attempts at intravenous line placement, fluid oozes from puncture sites. Fresh frozen plasma is administered while arrangements are made to transfer …