A newborn with subcutaneous nodules

Gulen Tuysuz, Nihal Ozdemir, Meltem Kivilcim, Hilal Aki, Yildiz Perk, Tiraje Celkan
2013 Türk Pediatri Arşivi  
Case Our patient who was born in another center with a birth weight of 3920 g as from the first pregnancy and as the first living child of a 38-year-old mother and a 42-year old father who had no consanguinity. No problem occured during the prenatal follow-up. The APGAR scores for the first and 5th minutes postnatally were assessed to be 9/10. No pathological finding was observed on physical examination. There was no ABO or Rh incompatibility between the mother and the baby. No additional test
more » ... No additional test was performed in the patient who had a normal birth weight and gestational week. The newborn was compliant with the mother and his nutrition was adequate. After a 24-hour follow-up period the patient was discharged following heel blood sampling for metabolic screening tests. Three days after discharge the patient was brought to our emergency outpatient clinic on the fourth postnatal day with complaints of decreased feeding, malaise and skin eruption which occured in the last one day. The newborn reflexes were decreased at presentation. The axillary temperature was found to be 38.2 0 C, the upper extremity arterial blood pressure was found to be 80/40 mm Hg and the pulse rate was found to be 162/min. Examination of the respiratory system was found to be normal. There was no pathological finding on examination of the cardiovascular system except for tachycardia. Widespread petechiae and ecchymoses which were prominent on the anterior part of the trunk, marked subcutaneous nodules on the back and hepatosplenomagaly (the liver was palpable 5 cm below the costal margin in the midclavicular line and the spleen was palpable 4 cm below the costal margin in the midclavicular line) were found on physical examination. Complete blood count, biochemical tests and coagulation tests were performed. No pathology was found in the biochemical and coagulation tests. Complete blood count was as follows: WBC: 51 600/mm 3 Hb: 12.5 g/dL, Hct: % 37 Plt: 16 000/mm 3 . LDH was found to be 1313 IU/L. Picture 1. Appearance of the subcutaneous nodules of the patient
doi:10.4274/tpa.1183 fatcat:hpt2dut7ebfpzavoyc2orz2jz4