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February 1994

Diffuse Petechial Pustular Lesions in a Newborn

Author Affiliations

USA; USN; USN; USA; Walter Reed Army Institute of Research, Washington, DC (Dr Smith); National Naval Medical Center, Washington, DC (Dr Yeager); Armed Forces Institute of Pathology, Washington, DC (Dr Skelton); and AIDS Registry, Washington, DC (Dr Angritt)

Arch Dermatol. 1994;130(2):248. doi:10.1001/archderm.1994.01690020117021

REPORT OF A CASE  The patient's mother presented febrile and in spontaneous labor in the second trimester of her pregnancy. The mother was positive for the human immunodeficiency virus (HIV) and had a history of drug abuse. The neonate was alive at birth with a diffuse papular, petechial, pustular eruption (Figure 1). Blood cultures were performed and the patient died soon thereafter. Blood cultures subsequently were positive for gram-positive coccobacilli.On autopsy, the placenta showed diffuse hematogenous placentitis with acute necrotizing villitis, acute intervillitis, and gram-positive coccobacilli demonstrated with Brown-Hopps stain. The patient's lungs showed acute bronchopneumonia with gram-positive coccobacilli. Examination of the skin revealed patchy involvement of the dermis with gram-positive coccobacilli. Within the area of involvement was a mononuclear infiltrate with focal areas of necrobiosis. In addition, groups of organisms could be found within the epidermis in association with spongiosis and exocytosis of mononuclear cells (Figure 2). Other

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