An interesting case from the newborn unit:
Thanks to Barbara Angus for this write up:
The patient is a newborn female who was noted to
have multiple blisters at 24 hours of life. She was the 2.8 kg product of a 38.7
week gestation to a 23 YO G1P0-1 woman with the following prenatal screens: O
positive, Ab neg, RI, RPR NR, HepBsAg neg, HIV neg, GBS neg, GC/chl neg. The
pregnancy was uncomplicated & the patient was born via NSVD without
complication. There were no septic risk factors including no prolonged rupture
of membranes. APGARs were 8 at 1 minute (-1 color, -1 resp) and 9 at 5 minutes
(-1 color). The patient was breastfeeding well and had no history of fevers, but
upon examination by the physician at 24 hours of life was noted to have multiple
blisters on the buttocks, thigh and hand.
FH: Mom denies any history of HSV. There are no
dermatologic conditions that run in the family.
PE: T-99.5 P-140 RR-36 Growth: Wt: 2.8 kg(10%) L:49
cm( 25%) HC: 32 cm (5%)
Otherwise physical exam was remarkable only for the skin findings: Dorsum of the
right hand had a 1.5 cm diameter area of denuded skin, c/ a red-yellow central
area, left labia had a 2.5 cm lesion also denuded c/ red-yellow center which
extended onto the thigh and a vesicle adjacent to this on the left thigh which
was 0.5 cm in diameter with amber fluid. The left buttock had 2 vesicles that
were 1 cm in diameter and contained amber fluid. No other skin lesions were
noted at this time.
Data:
CBC: WBC: 24.8 diff: 78P 16L 4M 2E, HCT: 52, Plts:
383
Blood culture pending
Diagnosis discussion
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