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A male term newborn of a 22-year-old primiparous woman, born after an uneventful pregnancy via normal vaginal delivery (Apgar scores of 9 and 10 at 1 and 5 minutes), birth weight of 3220 g, was admitted to the Neonatology Unit because of a generalized cutaneous eruption and leukocytosis with left shift during the first few hours of life. Other concurrent systemic symptoms were not detected. A hemogram showed 20.4 × 103 leukocytes/μL (60% of neutrophils). Findings from conventional biochemistry, thorax irradiation, blood cultures, and cerebral spinal fluid culture were normal. Alterations of the placenta and the umbilical cord were not recorded. After taking samples for hemocultures, the patient was empirically treated with cefotaxime sodium (150 mg intravenously for 12 hours) and vancomycin hydrochloride (30 mg intravenously for 8 hours), which were discontinued because of negative results. Physical examination revealed a healthy newborn with an erythematous cutaneous rash on the trunk (Figure 1), scalp, and extremities, with palmoplantar involvement and showing a number of vesicles and disseminated pustules, as well as desquamation (Figure 2). Mucosal involvement was not observed. Two weeks after the rash disappeared, the infant developed ungual lesions in all of the fingers of both hands, which consisted of yellow-brownish–colored proximal and medial dystrophic lesions with mild paronychia (Figure 3). The mother had a history of frequent recurrent vulvovaginitis, although postdelivery gynecological exploration findings were normal. Skin biopsy of one of the lesions was performed and samples were collected from pustules for a Gram stain, potassium hydroxide test, and culture.
Erythematous cutaneous rash on the trunk, showing a number of vesicles and pustules.
Palm involvement with pustules, as well as desquamation.
Proximal and medial dystrophic lesions with mild paronychia 2 weeks after the initial eruption.
What is your diagnosis?
Hernandez-Machin B, Reyes CS, Vargas MMO, Hernando LB. Picture of the Month—Quiz Case. Arch Pediatr Adolesc Med. 2007;161(9):907-908. doi:10.1001/archpedi.161.9.907