I saw a new born today at the neonatal ward. He is the first child, just delivered today by LSCS for fetal distress. Noted to have generalized erythematous wheals and papules. Some of the wheals and papules appear to form blisters. The mother had no history of any infection during her pregnancy. On examination the child appeared comfortable and not in distress. Sleeping and quiet. Afebrile. Generalised erythematous raised papules and wheals were noted on the face, trunk and upper limbs. Some of the wheals blanche with pressure. Tried to elicit darier’s sign – mild erythema but not raised. The wheals were intensely erythematous and inflamed on certain parts of the neck and face.
Clinically he has urticaria pigmentosa
His blood counts : TWBC 3100 Eosinophils 20%
Platelets 44 000
G6PD - pending
Though the rash appeared intense, the child was comfortable. Would you have started him on oral hydroxizine? Would you investigate further – hematological malignancy, etc the parents were advised about trigger factors (rubbing) and drugs (anesthetics, etc). thanks, Henry Foong
I'm not convinced about the diagnosis. First of all, although UP may be present at birth but more often erupt in later months. Furthermore in all of UP cases that I have seen the color of lesions are yeloow to choclate brown. I'm not sure but IMHO sometimes a simple erythema toxicum neonatarum may present quite as like as what i can see in these photos. Peripheral eosinophila is also in favor of erythema toxicum. I think it will fade after a few days and if not, further diagnostic studies would be necessary. Cheers, omid
ReplyDeleteIn our program, we put young patients with UP on cromolyn sodium QID and hydroxyzine QID. Interesting case. - Phung
ReplyDeleteI had a great deal of trouble posting a response. I
ReplyDeletefinally gave up. Then forgot that I hadn't done it.
Those lab values are grossly abnormal even for system
urticaria pigmentosa. They are likely from a heel
stick which may explian the platelet count...hopefully
its just clumped. They need a venous stick with a full
CBC with a manual differential. But that WBC is very
low too. I would get the peds hematologist involved
sooner rather than later to be sure this isn't
congenital leukemia
Posted for Melanie Austin, Pediatrician, Baltimore, MD