Congenital cutaneous candidiasis.

In the first hour of life the infant became tachypnoeic and was admitted to the special care nursery for investigation. On examination his weight of 3640g was appropriate for a gestational age of 39 weeks. He was tachypnoeic with an overinflated chest. There was a widespread erythematous rash over the neck, trunk and limbs. White cell count was 20.3 x 109/1, 85% neutrophils; platelets 238,000/mm3. Serum IgM was elevated at 0.44 g/l suggesting intrauterine infection (normal range <.02 g/l). Chest X-ray showed increased perihilar markings with mild patchy opacity in the right lung field. The clinical diagnosis was transient tachypnoea of the newborn but, as congenital pneumonia could not be excluded, he was commenced on intravenous benzylpenicillin and gentamicin. Over the next 24 hours his respiratory difficulty diminished. The rash became more macular, and changed over the next two days into papulovesicular lesions distributed over the trunk, face, palms of the hands and soles of the feet. There were no buccal lesions. At this stage, cultures of superficial skin swabs from ear, nares, umbilicus and erythematous skin and of gastric aspirate taken at birth grew Candida albicans, as did a bag specimen of urine. No bacteria were isolated. Blood cultures remained sterile.