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JAMA Clinical Challenge
September 4, 2013

A 4-Day-Old Neonate With a Widespread Vesicular Rash

Author Affiliations
  • 1Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
  • 2Richmond University Medical Center, Staten Island, New York
  • 3Brown University, Providence, Rhode Island
JAMA. 2013;310(9):971-972. doi:10.1001/jama.2013.276963

A 4-day-old male neonate born at 36 weeks via cesarean delivery because of breech positioning presented with a vesicular rash that developed hours after birth. The mother was 22 years old, gravida 3, para 3, without significant comorbid conditions. She received prenatal care during the pregnancy and was negative for hepatitis B surface antigen, human immunodeficiency virus, and reactive rapid plasma reagin. During prenatal care she tested positive for group B streptococcus and received appropriate treatment. She denied a history of sexually transmitted infections, cold sores, or genital lesions. Physical examination of the neonate demonstrated a preterm, nondistressed, healthy-appearing patient, with normal vital signs. Multiple 7- to 8-mm vesicles with erythematous bases, some with hemorrhagic crusting and others filled with clear fluid, were scattered over the chest, back, and extremities (Figure 1). Oropharyngeal lesions and neurologic deficits were not present. The remainder of the examination was unremarkable.