An 18-day old male neonate presented with fever, lethargy and poor feeding for a day. He was born by caesarean section with indication being non-progression of labour with birth weight of 2.9 kg. There was a history of bad child rearing practices like oil instillation through nose and cow's milk feeding. He had weight loss of 12% from birth weight, with mild tachypnoea and poor perfusion at admission. He had history of mosquito bite over nose following which redness spread over cheeks.
On examination, he had erythematous, indurated swelling over nose and both cheeks with raised margins.
Laboratory investigation showed leucocyte count of 12,120 cells/cu mm, 84% neutrophil, 12% lymphocyte, 4% monocyte, hemoglobin of 13.8 g/dl, platelet count of 4.4 Lakh/cu mm. C-reactive protein of 25 mg/L. Electrolytes were normal. Blood culture grew streptococcus pyogenes sensitive to ampicillin, penicillin, cefotaxim, vancomycin, ofloxacin and resistant to erythromycin and clindamycin. He received saline boluses and inotropic support at admission. He had thick oral secretions which improved with nebulisation. He had fever spikes for one day. He received injection meropenam and injection vancomycin for 2 days, which was changed to injection ampicillin and given it for 7 days.
Figure 1. Erythematous rash over cheeks and nose in a neonate side view.
Figure 2. Erythematous face over nose and cheeks, front view.
What is the diagnosis?