A full term vaginally delivered AGA baby born with these rashes! What do you think? Baby has no organomegaly, CBC normal and both the baby and mother VDRL negative (Prozone phenomenon excluded)

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Skin biopsy was done, following is the report : Biopsy shows modertely dense lichenoid infiltrate of histiocytes with slight epidermal hyperplasia. The histiocytes are large with abundant amphopilic cytoplasm and large bilobed kidney shaped nuclei. Several of these histiocyes are also present within the epidermis. The papillary dermis shows edema and extravasation of RBCs. Impression: Langerhans cell histiocytosis This is neonatal LCH restricted to skin, should improve in 3-4 months spontaneously. Will need follow up to monitor for systemic involvement

Toxic epidermaonecrolysis Ddx. Torch syndrome ADV. CBC , CRP, TORCH TEST , BLOOD FOR CULTURE AND SENSITIVITY TEST

Congenital varicella syndrome, Adv: torch profile mother and baby

This is not congenital varicella because: These babies frequently are born with limb hypoplasia and cicatricial cutaneous scarring. There often is microcephaly with cortical atrophy, and eye defects such as chorioretinitis, microphthalmia, or hypoplasia of the optic disc. There also may be poor development of the clavicle, scapula, and ribs, and scoliosis may be present. This is not congenital Rubella because: The baby is AGA, there is no organomegaly, no microcephalic, no thrombocytopenia, cataract or PDA. This is not neonatal varicella because mother has no varicella and these babies generally donot have lesions at birth. This is not neonatal herpes, the HSV lesions are group of vesicles, not generalised, the infection generally happens during birth and manifests few days down the line. These lesions are unlike epidermolysis bullosa. No peeling, no bullae.

If nothing viral or IUI is there to say definitely . some time few metabolic disease like GM1 gangliosis .present like this

At 5 weeks most skin lesions have healed , no systemic involvement and baby thriving well

Do septic screen... Blood culture.. If blister or bulla r/o.. Epidermolysis bullosa

There are no Bullae There is no risk factor for sepsis Baby born with rashes
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Congenital Varicella D/d Cutaneous mastocytosis Toxic epidermal necrosis

At 5 weeks all lesions healed, no systemic involvement and baby thriving well

Rule out congenial rubella and congenital varicella syndrome

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