March 2008

Fig.1

Fig.2

Fig.3

 

 


HISTORY OF PRESENT ILLNESS:
A newborn girl is transferred from an outside hospital because of concerning brown papules and ulcers scattered over her body.

The baby was delivered vaginally at full term without complications. Her Apgar scores were 9 and 9 at 1 minute and 5 minutes, respectively. At birth medical staff noted a large ulcerated lesion and brown-purple papules on the forehead. There were also scattered brown-purple nodules on the chest and back. She was transferred to St. Louis Children's Hospital for evaluation of these lesions and investigation of possible infectious etiologies. The baby was pink and well-perfused, in no apparent distress, and tolerating feeds well at the time of presentation.

PAST MEDICAL HISTORY:
Born to a G1P1 mother; HIV Negative, RPR Non-Reactive, Group B Strep Negative, Rubella Immune, Hep B Surface Ag Non-Reactive.

MEDICATIONS:
None
LABS:
CBC, CMP were within normal limits. Blood Culture positive for gram positive cocci in pairs and chains.
SOCIAL HISTORY:
Not Applicable.
PHYSICAL EXAM:
Vital Signs: Temp 37.4 RR 80 HR 168 BP 87/73
Head and Neck: Right upper forehead ­ Well circumscribed, punched out brown/purple ulcer without drainage, approx. 1.0 cm in diameter (Fig 1). 3 brown/purple papules, approximately 4-6 mm in diameter upper back, chest, abdomen (Figs. 2,3): 6-8 scattered brown/purple papules, approximately 4-6 mm in diameter on the lower extremities.The remainder of the physical exam was otherwise unremarkable: no mucosal lesions; no lymphadenopathy; no hepatosplenomegaly

 

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