Spot Diagnosis

Unilateral Erythema in a Premature Neonate

Teresa L. Almeida1,2, António Guerra1,2, Cátia R. Correia1, Madalena Tuna1
1Neonatal Intensive Care Unit, Department of Pediatrics, Hospital de São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, EPE, Lisboa, Portugal, 2Department of Pediatrics, Hospital do Espírito Santo de Évora, EPE, Évora, Portugal

Address for Correspondence: Teresa L. Almeida, Department of Pediatrics, Hospital do Espírito Santo de Évora, EPE, Évora, Portugal.
Email: teresaloualmeida@gmail.com
Keywords : Harlequin, color change, premature, neonate
Question :
A male neonate was born at 32 weeks of gestation due to a premature rupture of the membranes nine days before delivery. His birth weight was 1830 g (50th percentile), and Apgar scores were 6 at 1 minute and 8 at 5 minutes. He was admitted to the neonatal intensive care unit with respiratory distress and was placed on respiratory support with nasal continuous positive airway pressure, for the first 24 hours of life. On the third day of life, he had progressive respiratory deterioration and hemodynamic instability related to a bloodstream infection, with Klebsiella pneumoniae isolation in blood culture. Antibiotic treatment, volume expansion, and dopamine infusion were necessary to manage the septic shock. On the sixth day of life, he suddenly developed unilateral erythema with simultaneous contralateral pallor with a well-demarcated line separating the left and right sides of the body (Figure 1). During this episode, the physical examination was otherwise unremarkable, with no changes in vital signs. It resolved spontaneously within a few minutes.

Figure 1. Unilateral erythema with simultaneous contralateral pallor with a well-demarcated line separating the left and right sides of the body


What is the diagnosis?
 
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