Four hours after delivery in the 37th week of a normal pregnancy, a newborn boy (birth weight, 2.5 kg) developed blisters on his left hand (Figure 1). During the next day, gangrene of the fourth and fifth fingers was observed (Figure 2).
Initial laboratory findings were as follows: platelet count, 70 × 103/μL; C-reactive protein level, 7.0 mg/L; total bilirubin level, 14.9 mg/dL (254.8 μmol/L) (reference range, 0.0-1.0 mg/dL [0.0-17.1 μmol/L]) (indicating hyperbilirubinemia); direct bilirubin level, 1.3 mg/dL (2.2 μmol/L) (reference range, 0.0-0.3 mg/dL [0.0-0.4 μmol/L]); and indirect bilirubin level, 13.6 mg/dL (23.1 μmol/L) (reference range, 0.0-0.8 mg/dL [0.0-1.4 μmol/L]). Findings were normal for prothrombin time and negative for the presence of antinuclear antibodies, IgG cardiolipin antibodies, and D-dimer. The prothrombin index was 79% (reference range, 90%-120%); activated partial thromboplastin time was 44.5 seconds (reference range, 26-36 seconds). During the following days, the newborn developed leukocytosis (white blood cell count, 17.1 × 103/μL), and his C-reactive protein level increased to 13.79 mg/L.
Wollina U, Verma SB. Acute Digital Gangrene in a Newborn. Arch Dermatol. 2007;143(1):115-126. doi:10.1001/archderm.143.1.121