Spot diagnosis: An ominous rash in a newborn

Kam-Lun E Hon,King Woon Alan So,Kam-Lau Cheung,William Wong

doi:10.1186/1824-7288-35-10

Kam-Lun E Hon, King Woon Alan So + Show 2 more

Open Access

https://doi.org/10.1186/1824-7288-35-10

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Abstract

Purpura fulminans (PF) is an ominous cutaneous condition usually associated with meningococcemia. PF in the newborn is rarely reported. We report the case of a female preterm infant with extensive PF due to group B streptococcus (GBS) septicemia. She developed multi-organ system failure despite neonatal intensive care support and succumbed 9 days later. GBS, sensitive to penicillin, was isolated from the blood cultures of the mother and the infant. Invasive early GBS infection is common in the newborn and is empirically treated with prompt institution of intravenous antibiotics. PF associated with GBS is a rare cutaneous sign that must not be missed. Mortality remains high despite aggressive treatment and ICU support.

Highlights

Purpura fulminans (PF) is an ominous cutaneous condition usually associated with meningococcemia [1,2,3,4,5,6,7,8,9]
PF in the newborn is rarely reported [6,7,8,9,10,11,12] We report the case of a female preterm infant with extensive PF due to group B streptococcus (GBS) septicemia and discussion issues of management of this rare but often fatal condition
This report illustrates that PF is an ominous cutaneous sign of fulminant neonatal GBS septicemia

Summary

Introduction

Purpura fulminans (PF) is an ominous cutaneous condition usually associated with meningococcemia [1,2,3,4,5,6,7,8,9]. Purupura fulminans (PF) was immediately evident in a moribund 2.7 kg newborn girl delivered by emergency caesarean section for fetal tachycardia (200/minute by cardiotocography) at 35 week gestation 1. On arrival at the NICU, the baby developed further apneas with cyanosis followed by tachypnea, insucking chest and grunting Her mean arterial blood pressure was 30 mmHg and heart rate 190/minute. Group B streptococcus, sensitive to penicillin, was isolated from the blood cultures of the mother and the infant She was aggressively treated with broad antibiotic coverage, cardiopulmonary support with mechanical ventilation and multiple inotropes, and peritoneal dialysis (Table 1). PFuigrupruer1a fulminans (PF) Purupura fulminans (PF) was immediately evident in a moribund 2.7 kg newborn girl delivered by emergency caesarean section for fetal tachycardia (200/minute by cardiotocography) at 35 week gestation

Discussion

Darmstadt GL