Extramedullary haematopoiesis resembling a blueberry muffin, in a neonate.

To cite: Karmegaraj B, Vijayakumar S, Ramanathan R, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2014208473 DESCRIPTION A 5 h old baby girl born prematurely presented with fever and rash all over the body since birth. Her mother had a history of fever without rash for 1 week during the second trimester. On physical examination, the baby had microcephaly, symmetrical intrauterine growth retardation, rash all over the body, palpable orbital swelling surrounded by ecchymosis (figure 1), jaundice and hepatosplenomegaly. The rash consisted of bluish-red, firm non-blanching macules and papules 0.5–1.0 cm in diameter over the face (figure 1) and entire body (figure 2). Laboratory investigations revealed a haemoglobin level of 8.4 g/dL, white cell count of 44 000 cells/ mm with lymphocytosis (86%), platelet count of 34 000 cells/mm and conjugated hyperbilirubinemia (total bilirubin 17.5 mg/dL, direct bilirubin 5.5 mg/dL). A peripheral smear showed features of disseminated intravascular haemolysis and no evidence of blast cells. The baby’s coagulation profile was deranged (prothrombin time 36 s (control 14), international normalised ratio (INR)