Neonatal Inpatient Consults: Clinical and Pathological Insights for Benign and Serious Skin Conditions

The presentation discusses two neonatal cases involving skin conditions, providing insights into their clinical and pathological aspects. The first case involves a nine-day-old premature female with skin lesions and a diagnosis of primary cutaneous aspergillosis after initial suspicions of opportunistic fungal infections were confirmed through biopsy. Notably, the presence of calcium oxalate crystals, associated with cellular injury, was revealed to potentially signify an Aspergillus infection despite negative initial fungal stains. The baby was treated with liposomal amphotericin B, resulting in a positive outcome after 40 days. The second case centers on a seven-day-old full-term infant with soft tissue infections. After ruling out conditions like necrotizing fasciitis, a biopsy indicated subcutaneous fat necrosis of the newborn. Despite a typical presentation, the case revealed fluctuating nodules due to liquefied necrosis, managed without intervention. Additionally, the infant experienced hypercalcemia linked to the fat necrosis, which was treated effectively. Finally, two infants with juvenile xanthogranuloma (JXG) demonstrated the importance of molecular follow-up due to specific genetic markers that could indicate systemic involvement. Overall, the cases emphasize the complexity of neonatal skin conditions and the necessity for careful diagnostic and monitoring strategies.