What is your answer ?

A 5-day-old newborn male infant is transferred to your service for increased oxygen requirement and respiratory distress. He was born at 35 weeks of gestation to a 24-year-old lady, who is G7P6. She had seizure disorder for which she takes valproic acid and lamitrigine.
She had regular prenatal care and normal screening US. Delivery was complicated by PROM > 20 hr. Apgar was 9/9. Baby was nursed by mom in her room. On day 3 of life, mild tachypnea was noted and the physician on call performs the septic work up and started the baby on broad spectrum antibiotics. The following day, the baby was noted to be lethargic so LP was
done and IV cefotaxime was added. By early morning of day 5, the respiratory distress increased and baby needed intubation and then was transferred. On examination, you note the baby to be hypoactive with diminished reflexes. You order admission labs and repeat CXR. The nurse calls you as baby started to bleed from the nose. You noted oozing from the IV site. In the meantime, the lab calls you with panic report. CBC showed: WBC of 28 K, Plt 45K, PT 70, PTT 95, ALT 3567, AST 2458. The most likely diagnosis is
A. Fulminant GBS sepsis
B. Congenital Listerosis
C. Systemic HSV infection
D. Severe drug reaction
E. Parvo virus infection

7 Comments
  1. Reply
    Khadiga

    Severe drug reaction

  2. Reply
    Safaa ELMeneza

    Thank you lamiaa and khadiga
    Preferred response is C.
    Signs of liver failure in a neonate with sepsis (Cx neg) should raise the flag for HSV infection.

  3. Reply
    mariem abd el samee

    why HSV affects liver and elevate liver enzyme ?

  4. Reply
    mariem abd el samee

    there is no any history of rash mother or the baby?

  5. Reply
    mariem abd el samee

    what is the treatment?

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