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

8 Comments
Lamiaa Rehan
The case mostly..
Fulminant GBS sepsis
Khadiga
Severe drug reaction
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.
Lamiaa Rehan
Thanks for you dr Saffaa
mariem abd el samee
why HSV affects liver and elevate liver enzyme ?
mariem abd el samee
there is no any history of rash mother or the baby?
mariem abd el samee
what is the treatment?
Walaa
Many thanks dr safaa