Which presentation is consistent with neonatal disseminated herpes disease?

Which presentation is consistent with neonatal disseminated herpes disease?

• A. Hyperactive newborn with apparent spasticity
• B. Multiple papules scattered over the body
• C. Fever, grouped vesicles on the skin
• D. Purpuric rash in the acral distribution

Answer: (C)

Neonatal disseminated herpes disease most often presents as a systemic illness with fever accompanied by crops of grouped vesicles on the skin. The vesicles in HSV are typically clustered together in multiple lesions that can spread over the trunk and extremities, reflecting hematogenous spread to the skin and other organs. In disseminated disease, infants may also be irritable, lethargic, have poor feeding, and show signs of liver involvement or central nervous system involvement. This combination of fever and grouped vesicular lesions is much more characteristic of neonatal herpes than a hyperactive newborn with spasticity (which suggests withdrawal or other neurodevelopmental issues), a simple papular eruption (nonspecific rashes), or a purpuric acral rash (which points toward septicemia/DIC). When you see fever with grouped vesicles, prioritize HSV in the differential and pursue urgent evaluation and treatment with IV acyclovir.

Neonatal disseminated herpes disease most often presents as a systemic illness with fever accompanied by crops of grouped vesicles on the skin. The vesicles in HSV are typically clustered together in multiple lesions that can spread over the trunk and extremities, reflecting hematogenous spread to the skin and other organs. In disseminated disease, infants may also be irritable, lethargic, have poor feeding, and show signs of liver involvement or central nervous system involvement. This combination of fever and grouped vesicular lesions is much more characteristic of neonatal herpes than a hyperactive newborn with spasticity (which suggests withdrawal or other neurodevelopmental issues), a simple papular eruption (nonspecific rashes), or a purpuric acral rash (which points toward septicemia/DIC). When you see fever with grouped vesicles, prioritize HSV in the differential and pursue urgent evaluation and treatment with IV acyclovir.