Visual Diagnosis: 2-week-old Has a Red, Peeling Rash

Abstract

1. Anita Gupta, MD* 2. Norman Jacobs, MD† 1. *Neonatology Fellow, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL. 2. †Attending Physician, John H. Stroger Jr. Hospital of Cook County, Chicago, IL. A 2-week-old term female presents to the emergency department with a history of an abrupt, generalized red rash with peeling of the skin. Her mother reports that she first noticed the skin peeling around her daughter’s umbilicus 3 days ago, about the same time the umbilical cord stump fell off. She also noted some brownish discharge from the umbilicus at that time. Twenty-four hours earlier, the infant had developed irritability and a generalized red rash over her body, with areas of peeling skin. There is no history of fever, cold, hypothermia, cough, or eye discharge. Up to this point, the infant has been feeding and stooling well. The infant was born term via a normal spontaneous vaginal delivery without complications. Birthweight was 2,700 g, and Apgar scores were 9 and 9 at 1 and 5 minutes, respectively. However, the maternal group B Streptococcus status was unknown; the mother received two doses of intravenous penicillin 4 hours before delivery. On physical examination, the patient’s vital signs are appropriate for age, and there is no fever. The infant reacts to touch as if it hurts. Examination of the skin reveals erythroderma (scaling erythematous dermatitis) and large, thin sheets of peeling skin with underlying shallow, bright red erosions around the face (Fig 1), lower abdomen, axillae and antecubital fossae (Fig 2), and both ankles and feet (Fig 3). There are no vesicles or bullae. There is no increased erythema around, or oozing or crusting from, the periumbilical area. The mucous membranes of the mouth and anus are unaffected. The rest of the physical examination is normal for age. A clinical diagnosis is made. …