Neonatal Herpes Simplex Virus Infection
A baby girl was noted to have vesicular skin lesions immediately after spontaneous vaginal delivery at 32 weeks’ gestation. Her 37-year-old mother had premature rupture of membranes 12 days before the delivery. On physical examination, clusters of vesicles were seen on the infant’s torso (Panel A), periumbilical region (Panel B), and pharyngeal, nasal, and conjunctival mucosa. No lesions were seen on the mother’s genitals or the placenta. Polymerase-chain-reaction (PCR) testing of samples obtained from the infant’s skin, conjunctivae, pharynx, and blood were positive for herpes simplex virus type 1 (HSV-1). The results of chest radiography, lumbar puncture, and liver biochemical tests were normal. A diagnosis of neonatal HSV-1 infection that was confined to the skin, eyes, and mucosa was made. The mother reported no history of previous HSV-1 infection. However, a postpartum endocervical PCR assay was positive for HSV-1. In this case, a primary maternal infection late in pregnancy was thought to have led to ascending intrauterine infection and possibly preterm labor after prolonged rupture of membranes. Treatment with acyclovir was given. At 2 years of age, the child had had no recurrences and was developmentally normal.