Erythema annulare centrifugum as the presenting sign of Pseudomonas aeruginosa sepsis in a newborn
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CASE REPORT
Erythema annulare centrifugum as the presenting sign of Pseudomonas aeruginosa sepsis in a newborn Sumru Kavurt & Ozge Aydemir & Ulker Celik & Ahmet Yagmur Bas & Nihal Demirel
Received: 29 June 2012 / Revised: 2 August 2012 / Accepted: 30 August 2012 / Published online: 14 October 2012 # Springer-Verlag Berlin Heidelberg 2012
Abstract We report a case of erythema annulare centrifugum (EAC) with neonatal onset. The patient presented on the fourth day of life with erythematous papules that enlarged centrifugally to form annular or policyclic plaques on anterior surface of trunk and legs without signs of systemic toxicity. Subsequently, she developed sepsis and disseminated intravascular coagulation and died on the sixth day of life. Blood culture grew Pseudomonas aeruginosa. The coexistence of P. aeruginosa sepsis with the clinical appearance of erythema annulare centrifugum strongly suggests a pathogenetic effect of the microorganism on the skin eruption. To the best of our knowledge, this is the first report of EAC with P. aeruginosa sepsis in a newborn. Keywords Erythema annulare centrifugum . Pseudomonas aeruginosa . Sepsis
Introduction Annular erythemas include various more or less distinctly defined clinical entities mostly found in adults but are sometimes seen in infants. Erythema annulare centrifugum (EAC) is distinguished as one group among these dermatoses presenting with single or multiple annular or arcuate erythematous plaques on the face, neck, trunk, or extremities [4, 11]. S. Kavurt : O. Aydemir : U. Celik : A. Y. Bas : N. Demirel Department of Neonatology, Etlik Zübeyde Hanım Women’s Health Teaching and Research Hospital, Ankara, Turkey S. Kavurt (*) Neonatal Intensive Care Unit, Etlik Zübeyde Hanım Women’s Health Teaching and Research Hospital, Yeni Etlik Caddesi 55, Etlik, 06010 Ankara, Turkey e-mail: [email protected]
Histologically, an intense lymphohistiocytic cuffing occurs about the superficial and deep dermal vessels without epidermal involvement. The pathogenesis of the EAC is not clearly understood while bacterial, fungal and viral antigens, drugs, neoplasm, and autoimmune diseases have been described as possible causative factors [1]. We report a newborn who presented with EAC and Pseudomonas aeruginosa sepsis.
Case report A preterm female neonate, first of twins with a birth weight of 2,190 g was born to a second gravida mother at 34 weeks of gestation by vaginal delivery. Apgar scores were 6 and 8 at 1 and 5 min, respectively, and no resuscitation was required. There was no history of maternal medications. Syphilis serology during pregnancy was negative. No medication was administered at birth except for vitamin K intramuscularly. There was no maternal or other family history of skin, connective tissue, or autoimmune disease. After birth, there was respiratory distress and the infant was treated with nasal continuous positive airway pressure with a fraction of inspired oxygen of 30 %. Laboratory tests upon admission included a complete blood count (CBC) and blood cul
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