February 2006




History & Physical Exam:
A 12 day old infant was transferred from an outside hospitalto Washinton University
Childrens Hospital for evaluation of skin lesions present since birth.
Physical exam revealed widespread erosions and ulcerations (Figure 1 & 2). No pustules and no vesicles were noted. Mucous membranes were spared.
Infant's medical problems also included large patent ductus arteriosus (PDA), pulmonary failure requiring ventilatory support, renal failure with acidosis, thrombocytopenia and anemia.
Radiographic studies obtained on admission included
1. CXR with findings of metaphyseal bands in both humeri.
2. Head ultrasound showed cystic necrosis of the right frontal parietal cortex and cerebellum, asymmetrical dilated right lateral ventricles and bilateral thalamic intraparenchymal hemorrhage lesions.
Multiple blood, urine and CSF cultures on admission and from OSH were negative for bacterial infection.

Skin biopsy was performed.

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