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JAMA Clinical Challenge
March 1, 2016

Sudden Onset of Generalized Pustules in a Newborn

Author Affiliations
  • 1Department of Dermatology, Children’s Hospital of Zhengzhou, Zhengzhou, China
  • 2Department of Dermatology, The Second Affiliated Hospital of Soochow University, Suzhou, China
  • 3Department of Dermatology, Zhongnan Hospital of Wuhan University, Wuhan, China

Copyright 2016 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA. 2016;315(9):934-935. doi:10.1001/jama.2016.0006

A male neonate carried to term and born weighing 3.5 kg was delivered spontaneously to a 25-year-old woman. On day 3 after birth, he developed a widespread pustular rash, which began as erythema over the face and trunk and progressed rapidly over 12 hours. The mother had a benign prenatal course during pregnancy and had no history of syphilis, genital herpes, varicella, or vaginal candidiasis.

On examination, the infant was alert, well appearing, and afebrile. He had no lymphadenopathy or organomegaly. A diffuse eruption characterized by firm, 1- to 3-mm, discrete, thick-walled, yellow pustules on a red, swollen base was found over the face and trunk (Figure 1, left). Rare swollen areas of erythema and papules were scattered on the limbs, which showed a “flea-bitten” appearance (Figure 1, right). The pustular contents were sent for microscopic analysis including Wright stain, which showed large numbers of eosinophils, and Gram stain, potassium hydroxide preparation, and Tzanck smear, all of which were negative. Bacterial and fungal cultures of the pustules yielded no growth. Blood tests showed a white blood cell count of 12 000/μL (reference range for age, 5000-20 000/μL) with 31% neutrophils, 48% lymphocytes, and 11% eosinophils and normal hemoglobin level, erythrocyte sedimentation rate, and hepatic function.

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