0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Special Feature |

Radiological Case of the Month FREE

Carlo Bellini, MD, PhD; Mauro Oddone, MD; Ennio Biscaldi, MD; Giovanni Serra, MD
[+] Author Affiliations

Section Editor: Beverly P. Wood, MD


Arch Pediatr Adolesc Med. 2001;155(12):1381-1382. doi:10.1001/archpedi.155.12.1381.
Text Size: A A A
Published online

A FULL-TERM INFANT had asphyxia at 1 day of age. His weight was 3500 g; his length, 49 cm; and his head circumference, 36 cm (all parameters were between the 50th and 75th percentiles). Apgar scores were 1 and 5 at 1 minute and 5 minutes, respectively.

A tracheal intubation was performed because of asphyxia, bradycardia, and poor respiratory effort. The patient was treated with 12 hours of mechanical ventilation followed by continuous positive airway pressure ventilation for the next 3 days. Neonatal hypoglycemia was treated with intravenous dextrose, and metabolic acidosis with intravenous bicarbonate. The first day, seizures occurred lasting approximately 5 minutes. Dystonia, opisthotonos, and irritability were observed during the first week.

Brain magnetic resonance imaging indicated frontal regions of encephalomalacia and blood surrounding the left cerebellar hemisphere. On day 2, pitting edema appeared on the back, and there were dusky, reddish-purple nodular lesions on the neck and back. The overlying skin was taut with violaceous coloration, and the lesions were sharply circumscribed with an irregular surface. The affected area of the back extended from the neck to the thoracolumbar junction (Figure 1).

Magnetic resonance imaging of the lower cervical region and upper thorax was performed (Figure 2 ). The white blood cell count was 40 000/µL during the first week, then decreased to 15 000/µL. Polymorphonuclear leukocytes consistently made up 50% to 60% of the total number of white blood cells, and no nonsegmented polymorphonuclear cells were present. The erythrocyte sedimentation rate was 95 mm/h, and C-reactive protein reached a level of 9.3 mg/dL. Blood cultures and serologies were negative for toxoplasmosis, other agents, rubella, cytomegalovirus, and herpes simplex. An ultrasonographic evaluation showed no structural abnormalities of the kidneys or urinary tract. The skin lesions continued to enlarge for 2 weeks. When the patient was discharged at 2 months of age, the lesions had decreased to 60% of the former size.

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
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.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections