A 12-day-old Latin American boy, bom at 32 weeks and 3 days gestation to a 35-year-old G6P6 mother with limited prenatal care, was referred for evaluation of vesicular lesions noticed on day 6 of life. The infant was born by vacuum-assisted vaginal delivery complicated by respiratory distress. Following delivery, he was found to have hydrops fetalis, trisomy 21, and a large patent ductus arteriosus.Physical examination on day 12 of life was notable for crusted, erythematous plaques in the perioral a'nd postauricular areas, and slightly erythematous eroded papules, pustules, and plaques with honey-colored crusts involving the chest, abdomen, and back (Figs. 1 and 2). Extremities showed only mild xerosis, and the diaper-area was uninvolved. He had the facial features eharacteristic of trisomy 21 in addition to hepatosplenomegaly.Blood, cerebrospinal fluid (CSF), and swabs sampled from his eyes, nose, and skin lesions were all negative for herpesvirus (HSV) 1 and 2 polymerase chain reaction (PCR) and culture. Bacterial cultures were also negative. No chorioretinitis was noted on ophthalmologic exam.
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