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JAMA Clinical Challenge
November 2, 2011

Indurated, Purplish Plaque on a Newborn

Author Affiliations

Author Affiliation: Dr Chang (tina.chang@jama-archives.org) is Contributing Editor, JAMA.

JAMA. 2011;306(17):1923-1924. doi:10.1001/jama.2011.1577

A female neonate carried to term and born weighing 2.87 kg was delivered spontaneously to a 29-year-old woman with no medical illness. The infant had meconium aspiration at delivery and required mechanical ventilation for 2 days. Her hospital stay was complicated by the development of pneumothorax and recurrent hypoglycemia. On day 4 she developed thrombocytopenia and 3 days later was noted to have an erythematous patch on her back that was diagnosed as cellulitis and treated with intravenous antibiotics. However, the lesion persisted and dermatologic review on day 9 of her life revealed an indurated, well-defined purplish plaque measuring 10.5 × 8 cm over her back (Figure 1) that was tender and warm but nonpulsatile. The remaining findings of her physical examination were normal. She had been extubated successfully with no persistent respiratory symptoms, and there was no hepatosplenomegaly or lymphadenopathy.