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)