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Picture of the Month—Quiz Case
Jonathan M. Gaffin, MD;
Patrick G. Gallagher, MD
Arch Pediatr Adolesc Med. 2007;161(11):1102.
A male neonate was born at 37 weeks' gestation to a 21-year-old African American woman following a pregnancy complicated by a flu-like illness 3 weeks prior to delivery. Maternal prenatal laboratory evaluation revealed an O-negative blood type, negative serological results for hepatitis B, syphilis, and human immunodeficiency virus, and immunity to rubella.
On examination, the infant's weight, height, and head circumference were at the fifth percentile for gestational age. Skin examination revealed violaceous maculopapular lesions and petechiae over the face (Figure 1), trunk (Figure 2), and extremities. Physical examination was also notable for bilateral conjunctival hemorrhages and palpable hepatosplenomegaly.
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Figure 1. Violaceous macules and papules involving the face and trunk.
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Figure 2. Similar violaceous macules and papules observed on the trunk, buttocks, and leg.
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Laboratory investigation showed a hematocrit of 40% (reference range, 41%-65%), a platelet count of 42 000/µL (reference range, 150 000-450 000/µL), and a leukocyte count of 16 300/µL (reference range, 9400-34 000/µL) with 12% polymorphonuclear cells, 73% lymphocytes, and 9% monocytes. The prothrombin time was greater than 2 minutes (reference range, 12-23.5 seconds), and the partial thromboplastin time was 119 seconds (reference range, 35-52 seconds). The aspartate aminotransferase level was 338 IU/L (reference range, 14-70 IU/L; to convert to microkatals per liter, multiply by 0.0167); the alanine aminotransferase level was 52 IU/L (reference range, < 54 IU/L; to convert to microkatals per liter, multiply by 0.0167). The total and direct bilirubin levels were 3.9 mg/dL and 2.1 mg/dL, respectively (reference ranges, 2-6 mg/dL and < 0.5 mg/dL, respectively; to convert to micromoles per liter, multiply by 17.104). Head ultrasonography demonstrated bilateral calcification of the thalamic vessels (Figure 3) and right-sided intraparenchymal and intraventricular hemorrhage.
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Figure 3. Calcification of thalamic vessels (arrows) seen on a midsagittal view on head ultrasonography.
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What is your diagnosis?
Author Affiliations: Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut.
SECTION EDITORS: SAMIR S. SHAH, MD; ALBERT C. YAN, MD
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Picture of the Month—Diagnosis
Arch Pediatr Adolesc Med. 2007;161(11):1103.
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