An Unusual Pigmented Plaque in a Newborn

1. Jena Song, DO, MPH* 2. Jose Bustillo, DO* 3. Sherin Meledathu, DO* 1. *Department of Internal Medicine and Pediatrics, Newark Beth Israel Medical Center and Children’s of New Jersey, Newark, NJ A full-term, large for gestational age newborn girl, is born via vaginal delivery to a 32-year-old gravida 3, para 3 mother with a generally uncomplicated pregnancy. The pediatrics team has been called to the delivery for meconium-stained amniotic fluid. The infant does not appear to be in respiratory distress and has Apgar scores of 9 and 9 at 1 and 5 minutes, respectively. Her blood glucose level is 45 mg/dL. Upon inspection, she is noted to have a large, raised, hyperpigmented plaque covering the right side of her head, measuring 18 × 15 cm (Figs 1 and 2). This plaque is accompanied by greater than 20 other macules, patches, and plaques diffusely distributed throughout the body that are either hyper or hypopigmented, have either smooth or irregular borders, and vary in size from 0.5 to 3 cm (Fig 3). The patient also has multiple areas of blue-gray pigmented patches on her sacrum, but no sacral dimple is evident. Her neurologic examination reveals a newborn who is alert, responsive, and has normal primitive reflexes and tone for gestational age. Her head circumference is 35.5 cm (53rd percentile). No dysmorphic features are noted, and the remainder of the examination is remarkable only for a systolic heart murmur. Figure 1. Gross visualization of plaque throughout the body. A large, raised, hyperpigmented plaque, measuring 18 × 15 cm, covering the right side of the infant’s scalp. © 2017–2020, Jena Song, DO, MPH. All rights reserved. Reprinted with permission. Figure 2. Gross visualization of plaque throughout the body. Further visualization of large, hyperpigmented plaque extending to the right maxillary region and right upper eyelid. © 2017–2020, Jena Song, DO, MPH. All rights reserved. Reprinted with permission. Figure 3. Gross visualization of plaque throughout the body. Numerous hyperpigmented macules, patches, and patches of smaller caliber covering the right shoulder, posterior neck, back, …