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What is the diagnosis

emad shatla

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Preterm baby 35 week was admitted to NICU for total 5 days

All investigations were normal including blood C/S , CRP CBC And serum Electrolytes

In day 4 , Baby develop this rash only for 20 minutes then disappear without treatment

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Looks strange!

Bulleaous skin changes or flat?

Erythematoues (compressable)?

History sounds like some kind of Harlequin phenomena but the images does not really look like it I think.

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it seems , that the clamp device of umbilicus is to low to the skin and even involved..

but in this case some treatment was done :)

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No treatment was given as the skin rash disappeared within 20 mint. Only part of history to be added is the baby was just shifted from incubator care to cot and the temp was 36.3 ? I put diagnosis of vascular Immaturity as the diagnosis ?

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If the baby had or had had an umbilical artery line, I would guess "cath toes"- perfusion issue related to arteriospasm.

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As this rash came and disappeared in 20 minutes it looks like urticarial reaction

I didnt see the picture but cutis mormorata can occur in cold stress and once the baby temp improved the rash disappeared

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 Hi.It Seems cutis marmorata where the skin has a pinkish blue mottled  or morbeled appearence when exposed to cold stress.

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Hi friends.This rash seems a vasogenic reaction  such as urticaria ,because there are few erythematous patches on skin.

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This finding seems to be "livedo reticularis" . You can interpret that as "exagerated cutis marmaratus". Did you investigate in terms of antiphosholipid syndrome? If this finding occured on DOL 4, how could he be discharged ? I saw this finding in babies who were suddenly developed  vasomotor spasm (whatever the reason is). In this situation, If it could be removed the reason and secured the circulation, the problem would ended up.

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antiphosholipid syndrome. Was not investigated . But no family history to support this diagnosis , whatever the next FU in clinic, I will take care of it.

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We have had a similar case reciently in our unity. The images are very very similar (near identical). It was a newborn from other hospital traslated to our center. At the first moment the left feet was blanked, and a similar blue pattern was visible in the left leg, and left side of the abdomen.
In less than 2 hour the event was resolved expontanely.

The diagnosis was air embolism caused for a IV device manipulation, the air entered in the arterial circuit by a shunt (foramen ovale, ductus...).

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Looking at history and picture, the transient and localised status of rash, It could be :
  Cutis marmorata telangiectatica congenita
 (also called congenital generalized lymphangiectasia )
salient features  are
- dilated superficial venous and capillary channels. 
- classic - reddish-blue reticulation of the skin changes with crying (becomes increasingly red) or other stimulation (becomes livid with cooling).
- Mostly  generalized,but there maybe segmental or localized involvement as in this infant 
 
Regards
 
Dr H Sharma

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Hi Friends!greetingsfrom  Hyderabad India,

 

Could it be a variant of erythema toxicum neonatorum it is also a transient phenomenon.

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I think from your explanation of the history, appearance of a rash after moving the baby and disappearance within 20 min this could be " Harlequins skin changes". PS; I couldn't find any pictures.

 

 

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