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JAMA Pediatrics Clinical Challenge
December 2015

A Crusted Papule in a Premature Neonate

Author Affiliations
  • 1Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia
  • 2Division of Dermatology, Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
JAMA Pediatr. 2015;169(12):1173-1174. doi:10.1001/jamapediatrics.2015.1359

A male neonate was born at 25 weeks’ gestation by cesarean delivery because of hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome in his primigravid mother, who also had systemic lupus erythematosus managed with hydroxychloroquine, aspirin, and prednisone during pregnancy. The patient’s premature birth was complicated by acute respiratory distress that necessitated intubation and necrotizing enterocolitis that required parenteral nutrition. At birth, the patient was found to be mildly anemic (hemoglobin level, 11.0 g/dL [to convert to grams per liter, multiply by 10]) and thrombocytopenic (platelet count, 120 × 103/µL [to convert to 109/L, multiply by 1]) with concomitant intraventricular hemorrhage. Although afebrile, he was treated empirically for sepsis with vancomycin hydrochloride and cefepime hydrochloride. A cerebrospinal fluid culture result was positive for Staphylococcus epidermidis, but the results of additional blood cultures were negative for organisms. On day 8 after birth, a 0.5-cm, circular, crusted papule with a surrounding rim of erythema on the left hip was noted (Figure, A). A punch biopsy of the lesion was performed (Figure, B and C).

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