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JAMA Pediatrics Clinical Challenge
January 2014

Newborn With Unexpected Skin Lesions

Author Affiliations
  • 1Pediatric Department, Hospital de Santa Maria, Lisbon, Portugal
  • 2Pediatric Infectious Diseases, Pediatric Department, Hospital de Santa Maria, Lisbon, Portugal
  • 3Dermatology Department, Hospital de Santa Maria, Lisbon, Portugal
  • 4Gynecology-Obstetrics Department, Alfredo da Costa Maternity Hospital, Lisbon, Portugal
JAMA Pediatr. 2014;168(1):91-92. doi:10.1001/jamapediatrics.2013.3440

A 25-day-old newborn was admitted to our hospital with a diagnosis of bronchiolitis. During admission, the infant developed violaceous skin lesions with edema in inguinal and axillary regions (Figure). Lesions became ulcerated within 3 to 4 days, with infarcted necrotic areas. Blood tests showed leukopenia (white blood cell count, 2460/μL) with neutropenia (neutrophil count, 220/μL) (to convert both to ×109 per liter, multiply by 0.001). The lesions were biopsied and samples were sent for cultures and histopathological analysis. Intravenous floxacillin was started, followed by surgical debridement due to progression of the major lesions.