A Newborn With Cutaneous Lesions and Hematochezia

Salvatore E. Mignano, DO; Hemant Pal, MD


June 12, 2017

A healthy, full-term male infant was born by vaginal delivery to a 26-year-old gravida 5 para 1 woman with a history of herpes simplex virus infection, successful conversion of breech presentation at 36 weeks, and administration of RhoGAM at 28 weeks of pregnancy.

The initial physical exam was unremarkable, except for a dark, 2.0-mm, smooth, ovoid, red-violet papule on the newborn's trunk. Within 24 hours of birth, multiple similarly sized ovoid red-violet papules and macules appeared on his right leg, trunk, and chin (Figure 1a and 1b). The lesions were not ulcerated and did not appear to cause distress to the baby, who did not seem to be pruritic. No other findings were observed on physical exam.

Figure 1a. A 2.0-mm red-violet papule on the patient's chin. b. Multiple similar papules throughout the patient's body, including on his abdomen and extremities.

At 36 hours of life, the infant was admitted to the neonatal intensive care unit. The only abnormality in the complete blood count was thrombocytopenia. Viral serologies were negative, and there were no signs of infection. Imaging and ophthalmologic exams were all normal.

On the third day of life, the infant developed hematochezia, but continued to have normal vital signs and did not require supplemental oxygen, antibiotics, or antiviral agents. The infant's intake and output were normal for age. The thrombocytopenia was refractory, not improving with unmatched platelet transfusions. Human leukocyte antigen (HLA)-matched platelets yielded a similar lack of response.

Over the next few days, the patient was treated for thrombocytopenia with platelet transfusions (HLA matched and unmatched) and intravenous immune globulin. On the ninth day of life, he was discharged from the neonatal intensive care unit with close follow-up at the hematology/oncology clinic for thrombocytopenia, cutaneous lesions, and persistent hematochezia.


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