August-September 2017

HPI: A 1 day old full term female infant was born with ‘hemorrhagic pustules’ on face, trunk and extremities.
The Infant was born at EGA 39 1/7 by vaginal delivery following elective induction of labor. Delivery was uncomplicated, with APGAR scores 9 and 9 at 1 and 5 minutes of life respectively. Mother denied having episodes of fever or viral illness during pregnancy. Maternal serologies were negative (rubella immune, negative Coombs, HIV, RPR, GC/CT, GBS, and HepBsAg). There was no maternal history of varicella or HSV, and no genital lesions were noted during delivery.
Given the presence of lesions on scalp and trunk shortly after birth, there was concern for an infectious etiology, including HSV. Patient was therefore started on empiric ampicillin, gentamicin, and acyclovir prior to transfer to SLCH NICU. Infant remained afebrile with stable vital signs throughout hospital course. Following evaluation by dermatology, a punch biopsy of a crusted papule on the left thigh was performed.

Past Medical History: Mother is a 25 year old G4P2->3 A+ blood type with negative serologies.

Family History: Not contributory

Allergies: NKDA

Medications: Ampicillin, gentamycin, acyclovir, continued at time of transfer

Physical Exam: On examination there were multiple crusted erythematous papules on scalp, face (Figure 1), back, (Figure 2), and left anterior thigh (Figure 3).