CASE DESCRIPTION
A preterm female neonate, gestational age 36 weeks by Ballard score with an unremarkable past prenatal history, vaginal delivery, adequate weight for gestational age (2730 g). Her mother was a 26-year old, gravida 1, para 0, with a medical history of recurrent urinary tract infections and fungal vaginosis treated during pregnancy. She did not have a vaginal leak, blood, or premature rupture of the membrane before the onset of labor. Spontaneous neonatal adaptation with APGAR scores 7 and 8 at 1 and 5 minutes, respectively. Silverman’s scoring system was 3-4. She had low oxygen saturation levels impending respiratory distress therefore, she received non-invasive respiratory support for 24 hours with an adequate response.
During delivery, there was no umbilical cord compromise. Immediately at birth, on examination, multiple erythematous desquamative plaques along with papules and vesicles localized in the back, abdomen, lower and upper extremities, neck, axillary region, retro auricular region, and groin area were observed. Skin lesions had a burning-like dermatitis appearance. There was no palmar or plantar compromise nor mucose and skin appendages involvement. (Figure 1)
Cerebral, abdominal, and cardiac ultrasound were unremarkable. Chest radiography and lumbar puncture were within normal limits. The patient had no ophthalmological compromise. Bloodwork showed a total leukocyte count of 50130/mm3, neutrophil count of 32720/m3. Blood cultures were negative after 72 hours and, gastric culture on Sabouraud’s dextrose agar and skin potassium hydroxide preparation (KOH) were positive for Candida Albicans yeast. Further evaluation ruled out immunodeficiency virus, syphilis, and hepatitis B and C infection. The study of lymphocyte subpopulations showed normal immunoglobulin, T lymphocyte, and B lymphocyte levels.
At the neonatal intensive care unit (NICU), the patient received topical Nystatin 100,000 units/g cream four times per day and an intravenous fluconazole loading dose of 25mg/kg, followed by 12mg/day IV for seven days. Subsequently, oral fluconazole 12 mg/day and topical Clotrimazole 1% were continued for 7 days with an adequate response. (Figures 2-4)