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January 1994

Pathological Case of the Month

Arch Pediatr Adolesc Med. 1994;148(1):61-62. doi:10.1001/archpedi.1994.02170010063013

A 4-DAY-OLD MALE infant was referred to the dermatology service for evaluation of taut skin with overlying violaceous discoloration. He was born by cesarean section following a pregnancy complicated by insulin-dependent diabetes at term. At birth, he was limp and cyanotic and required cardiopulmonary resuscitation. Apgar scores were 1,4, and 7 at 1,5, and 10 minutes, respectively, and initial umbilical cord blood pH was 6.88. Birth weight was 3967 g. The infant was cyanotic with cool extremities and symmetrically decreased tone without Moro or tonic neck reflexes. Owing to development of neutropenia and hypotension, he was treated intravenously with ampicillin sodium, gentamycin sulfate, acyclovirsodium, white-blood cells, γ-globulin, and dopamine. No infectious agent was identified. He also developed cardiomegaly and congestive heart failure. Computed tomography of the head showed a venous sinus thrombosis at the posterior confluence of the sinuses and left occipital and cerebellar hemorrhages.

Skin examination revealed multiple, violaceous, firm,