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JAMA Clinical Challenge |

Indurated, Purplish Plaque on a Newborn

Huan J. Chang, MD, MPH
JAMA. 2011;306(17):1923-1924. doi:10.1001/jama.2011.1577.
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A female neonate carried to term and born weighing 2.87 kg was delivered spontaneously to a 29-year-old woman with no medical illness. The infant had meconium aspiration at delivery and required mechanical ventilation for 2 days. Her hospital stay was complicated by the development of pneumothorax and recurrent hypoglycemia. On day 4 she developed thrombocytopenia and 3 days later was noted to have an erythematous patch on her back that was diagnosed as cellulitis and treated with intravenous antibiotics. However, the lesion persisted and dermatologic review on day 9 of her life revealed an indurated, well-defined purplish plaque measuring 10.5 × 8 cm over her back (Figure 1) that was tender and warm but nonpulsatile. The remaining findings of her physical examination were normal. She had been extubated successfully with no persistent respiratory symptoms, and there was no hepatosplenomegaly or lymphadenopathy.

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Figure 1. An indurated, well-defined purplish plaque measuring 10.5 × 8 cm was observed on the patient's back (figure reprinted from Arch Pediatr Adolesc Med. 2011;165[6]:563-5641).
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Figure 2. Skin biopsy showing septal and lobular inflammatory infiltrate of lymphocytes (green arrowhead), plasma cells, histiocytes (blue arrowhead), and a few eosinophils (black arrowhead) wedged in between the fat cells in subcutaneous fat. Fat cells contain fine, eosinophilic cytoplasmic strands forming clefts (arrow) (hematoxylin-eosin, original magnification ×40) (figure reprinted from Arch Pediatr Adolesc Med. 2011;165[6]:563-5641).
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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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