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Saturday, February 7, 2015

Strange lesions on a newborn's back


Today's case has a bit of a Dr. House vibe. A pre-term newborn girl was being kept under observation at the intensive care unit of a hospital in India. 5 days after birth, multiple red lesions appeared on her skin and spread rapidly over the next two days, covering the neck, back, arms and hands. 


The infant's mother was 23 years old and healthy. She had not suffered from any serious illnesses since childhood. This had been her first pregnancy. At 34 weeks, premature membrane rupture with evidence of fetal distress necessitated an emergency Caesarean section.

Clinical examination of the child 7 days after birth revealed an alert infant weighing 1.98 kg, with good reflexes. Large, ring-shaped, slightly thickened red lesions were clearly visible on her skin. The center of the lesions showed fine, detachable scales without any atrophy. Physicians initially suspected neonatal lupus erythematosus, an autoimmune disease. However, the mother had no history of any such disorder. Laboratory tests of blood and urine were performed, but neither the child nor the mother showed any abnormalities. The mother also tested negative for venereal diseases.


Can you guess what the diagnosis was?



Image from: Palit & Inamadar (2012)


The answer: tinea corporis, more commonly known as ringworm! It turned out that the lesions were caused by a fungal infection. 


The infant was treated with terbinafine hydrochloride cream (1%) applied once daily. After antifungal treatment, the skin lesions improved significantly in 2 weeks and disappeared completely after 4 weeks. 

How can a newborn baby get ringworm just five days after birth? The source turned out to be the child's grandmother, who used to handle the child bare-handed while assisting with breastfeeding. She was found to have a fungal infection of several fingernails, and was advised to try monthly pulse therapy with systemic terbinafine.


Source:

Palit A, Inamadar AC. (2012) Annular, erythematous skin lesions in a neonate. Indian Dermatol Online J. 3(1): 45–47. 



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