An erythematous rash, diarrhea, failure to thrive, and lymphadenopathy in a 3-month-old girl.

HISTORY OF PRESENT ILLNESS The patient was a 3300 g product of a 37-week gestation. The pregnancy was complicated by pre-eclampsia. The newborn infant was noted to regurgitate much of her feeding. A barium swallow showed pyloric stenosis, pyloromyotomy was performed at 2 weeks of age and the problem resolved. At 3 weeks of age, she developed an erythematous, exfoliative rash that began on the cheeks and spread over the entire body. The rash would scale, flake, and sometimes weep a serous fluid, but there were no vesicles or bullae. Treatment with lubrication was ineffective. The infant was noted to have poor weight gain and at age 2 months was admitted to another institution with fever and diarrhea. She was treated for a presumed skin super-infection with antibiotics. She was readmitted 1 week later with the same symptoms. Blood, urine, and cerebrospinal fluid cultures revealed no bacterial pathogens and she was discharged. At 3 months of age, she developed high spiking fevers and was admitted to our institution for further evaluation. Past medical history was otherwise notable only for frequent diarrhea. She had achieved appropriate developmental milestones. The parents were nonconsanguineous and this was the first pregnancy. The mother received prenatal care, was rubella immune, and had a negative serologic test for syphilis. There was no family history of early infant deaths, skin diseases, atopic disorders, immune deficiency or collagen vascular disease. The patient was immunized only with one dose of hepatitis B vaccine.