A full-term, 2.76-kg female newborn infant in respiratory distress was delivered by emergency cesarean section from her 27-year-old primigravida mother. The prenatal period was uneventful, the baby's father had been in good health, and the family history yielded no information of concern. The infant had multiple, nodular, purplish skin lesions approximately 2 to 5 mm in diameter on her trunk and limbs. In addition, multiple smooth, mobile, and firm subcutaneous nodules approximately 0.5 to 1 cm in diameter were palpable in the limbs. Her face was not dysmorphic. On admission, her fundi were normal, but at follow-up examinations, hypopigmented retinal lesions were observed. Moderate subcostal retractions were present, and a grade 2/6 murmur was audible along the left sternal border. Her liver was palpable 3 to 4 cm below the right costal margin and was firm and nodular. The spleen also was moderately enlarged and firm. The infant appeared neurologically