Visual Diagnosis: A Neonate with Rash and Fever

Rebecca Shay; Wendy Hoffner; Deena Zeltser; Marcus Mitchell

doi:10.1542/pir.2016-0095

This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.

Download PDF

Rebecca Shay, MD*
Wendy Hoffner, MD^†,^‡
Deena Zeltser, MD^‡
Marcus Mitchell, MD^§

^*Pediatric Division and
^†Hospitalist Division, Children’s National Health System, Washington, DC
^‡Pediatric Division, Holy Cross Hospital, Silver Spring, MD
^§George Washington University School of Medicine and Health Sciences, Washington, DC

AUTHOR DISCLOSURE
Drs Shay, Hoffner, Zeltser, and Mitchell have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Presentation

A 10-day-old girl is brought to the emergency department (ED) with fever and rash. Her parents report that multiple small red spots developed over the trunk and back in the 2 days before presentation. She was seen twice by the primary care physician (PCP) during this time, and she was diagnosed as having erythema toxicum. The PCP told the parents that she could soon develop small pustules and provided reassurance and anticipatory guidance during each visit. On the day before hospital admission, the rash began to worsen, with fluid-filled lesions developing over the areas of redness. That evening, the patient felt warm to the touch, and she had axillary temperatures of 100.9°F to 102.0°F (38.3°C–38.9°C). Her parents bring her to the ED for further evaluation.

The parents report that the patient has otherwise been well; she is feeding well and has a normal level of activity and alertness. The parents deny fussiness, irritability, or sick contacts. The patient has been in recent contact with her healthy and immunized school-aged cousins. The patient’s birth history is normal. She was born at full term to a primigravida healthy mother. There were no pregnancy or delivery complications. The results of all prenatal laboratory studies were negative, including group B Streptococcus. There was no history of maternal vaginal lesions, cold sores, or herpes simplex virus (HSV).

On arrival at the ED, the patient is febrile with a rectal temperature of 101.9°F (38.8°C), but her remaining vital signs are normal. On examination, she is vigorous …