Congenital cutaneous candidiasis associated with respiratory distress and elevation of liver function tests: A case report and review of the literature,☆☆,

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Abstract

We describe congenital cutaneous candidiasis (CCC) in a term newborn. The mother had candidal vaginitis 1 week before delivery. At birth, the infant had a generalized, intensely erythematous, papulovesicular eruption, respiratory distress and elevation of liver function tests. The child responded well to intravenous amphotericin B plus topical and oral nystatin. There have been 13 previously reported cases of CCC in infants weighing more than 1500 gm who had evidence of systemic infection. Two deaths were attributed to candidal pneumonia and sepsis. The majority of infants with CCC have infection localized to the skin, but if there is any evidence of respiratory distress or signs of sepsis the possibility of systemic candidiasis and the need for parenteral antifungal therapy must be considered. (J Am Acad Dermatol 1997;37:817-23.)

Section snippets

CASE REPORT

A 3820 gm girl was born at term to a 35-year-old gravida 2 para 1 white woman who had good prenatal care. Maternal serologic screening was negative for human immunodeficiency virus, hepatitis B, and syphilis. Cultures for Chlamydia, group B streptococcus, and gonococcus were negative. There was no history of herpes simplex infection. The mother had been treated with terconazole vaginal suppositories 1 week before delivery for severe candidal vaginitis. At that time, the mother suspected that

DISCUSSION

CCC was first described by Sonnenschein et al. in 1960. 5 Fewer than 100 cases of CCC have been reported in the English-language literature. 4, 8

The pathogenesis of CCC is only partially understood. Sonnenschein et al. 5 thought that CCC might result from the combination of vaginal candidal infection, prolonged rupture of membranes, and intensive administration of antibiotics, all of which their first patient had. Most cases reported since then have followed maternal candidal vulvovaginitis,

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    This article is made possible through an educational grant from the Dermatological Division, Ortho Pharmaceutical Corporation.

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    Reprint requests: Franklin P. Flowers, MD, Division of Dermatology and Cutaneous Surgery, PO Box 100277, Gainesville, FL 32610-0277.

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