The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.
At 6 days of life, an infant is presented to a pediatrician for a scheduled visit. The full-term male infant was born via vaginal delivery after uncomplicated pregnancy and labor. During the newborn examination, a midline, dermal lesion was noted at the L3-L4 spinal segment. It was described as purple-red in hue and slightly raised. The lesion was noted to be irregular; it measured approximately 1.5 cm × 2 cm and had a small, 1-mm central dermal pit. It did not blanch, was not firm to touch, and was seemingly nontender.
During the newborn examination, neurology findings were normal, with good lower extremity tone, normal reflexes, and normal sensation. The remainder of the infant's examination findings were unremarkable, including normal results on anal examination and male genitourinary examination. During his nursery stay, he voided and stooled normally. He was discharged with instructions for a scheduled newborn visit. No imaging was done in the nursery.
Three days later, the infant is now presented to the pediatrician. He is well-appearing, has been feeding adequately, and is stooling and voiding normally. The lesion has changed slightly, with new, faint, ill-defined, macular erythema that extends from the original cutaneous lesion towards his left flank (Figure 1). The original papular lesion and the central dermal pit are unchanged, and no drainage from the pit has occurred.
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Cite this: Dan Beardmore, Saba Fatima. A Newborn Infant With a Lumbar Lesion and Dermal Defect - Medscape - May 15, 2018.