A 3-day-old male is referred to your hospital for admission and evaluation after “blueberry muffin spots.” are noted at delivery. These lesions reportedly start as a “blood blister,” which then open up and crust over. The lesions do not bleed. He has not had fevers and his mother did not have any known exposures or illnesses during pregnancy. The patient is the product of a term pregnancy complicated by late prenatal care, which was first obtained at approximately 6 months’ gestation. Maternal labs are within normal limits. This is a first pregnancy, the patient is of Caucasian descent, and the parents are in good health. Family history is negative for any bleeding or clotting disorders.
On physical examination the patient is noted to have scattered 2 mm–8 mm well-circumscribed erythematous purple papules, several with rolled borders and central hemorrhagic crusting. Numerous lesions are noted on the frontal scalp, with several on the face, extremities, and buttocks. No purpura are noted. The examination is otherwise unremarkable.