PHOTO ROUNDS Nataliya Holmes, MD; Jennifer J. Walker, MD, MPH; Newborn with desquamating Will Chapple, MD Hawaii Island Family Health Center, Hilo (Drs. Holmes and rash Walker); Paniolo Family Medicine, Kamuela (Dr. Chapple), Hawaii The patient’s age and the appearance of the lesions
[email protected] pointed us to the proper diagnosis in this case. DEPARTMENT EDITOR Richard P. Usatine, MD University of Texas Health at San Antonio a 9-day-old boy was brought to the emergen- (FIGURE) with a small amount of dried sero- The authors reported no potential cy department by his mother. The infant had sanguinous drainage and similar superficial conflict of interest relevant to this article. been doing well until his most recent diaper peeling lesions at the left preauricular area and change when his mother noticed a rash around anterior chest. There was no underlying fluctu- the umbilicus (FIGURE), genitalia, and anus. ance and only minimal surrounding erythema. The infant was born at term via sponta- neous vaginal delivery. The pregnancy was ● WHAT IS YOUR DIAGNOSIS? uncomplicated; the infant’s mother was group B strep negative. Following a routine postpar- ● HOW WOULD YOU TREAT THIS tum course, the infant underwent an elective PATIENT? circumcision before hospital discharge on his second day of life. There were no interval re- ports of irritability, poor feeding, fevers, vomit- ing, or changes in urine or stool output. FIGURE The mother denied any recent unusual exposures, sick contacts, or travel. However, Peeling skin on temple and chest with upon further questioning, the mother not- erythematous rash at umbilical stump and genitalia ed that she herself had several small open wounds on the torso that she attributed to un- treated methicillin-resistant Staphylococcus aureus (MRSA).