Case 1: Skin Lesions in a Well Newborn: Can They Be Life-threatening?

Abstract

A 1-day-old girl is admitted to the NICU after she is discovered to have crusted skin lesions on her trunk, face, and lower limbs during routine newborn examination. She is born at term by vaginal delivery following a normal pregnancy to a primigravida mother with no perinatal problems. Apgar scores are 8 and 9 at 1 and 5 minutes, respectively. The parents are not consanguineous and there are no genetic diseases or unexplained infant deaths in the family history. The infant is breastfeeding well. On physical examination, hemorrhagic crusted papules measuring 3 to 5 mm are noted on the trunk, face, and extremities (Fig 1, Fig 2, and Fig 3). Findings of the rest of the systemic examination are otherwise normal, and the infant looks well with normal vital signs. The dermatologist is consulted and empiric treatment with intravenous ampicillin and gentamicin is started for possible nonbullous impetigo, even though the patient is well. Complete blood cell count, blood film, C-reactive protein, serum electrolytes, liver function tests, urea and creatinine, coagulation studies, blood culture, skin swab from the lesion, and screening for toxoplasmosis, other (syphilis, varicella-zoster, parvovirus B19), rubella, cytomegalovirus, and herpes infections (TORCH) are all normal. The antibiotics are stopped after 72 hours after Gram staining of the crusted lesions yields no microorganisms and no growth is seen …