A three-day-old male with asymptomatic jaundice was admitted to the hospital. First-born by vaginal delivery to a young mother at 39 weeks of gestation; Apgar 9/9, weight 2850g, height 50cm, no history of chronic diseases. The mother denied infectious diseases during this pregnancy.

Upon admission, the patient was in good general condition with widespread jaundice tone, abdomen with no evidence of neither hepato nor splenomegaly or peritoneal irritation; normal upper and lower extremities with capillary refill of 2s. Routine blood exams showed leukopenia and total bilirubin of 17.9mg/dl. He was managed with continuous blue light therapy.

About 48h after, he had developed fever (38°C) with chills and increased irritability. The physical evaluation revealed, rash and purple lesions on chest and extremities. Also, bruises on the nose, ears and dorsal region of feet; the capillary filling increased to 5s (Fig. 1). He was given empirical treatment with cefotaxime and amikacin. Besides, blood samples for cultures were taken prior to antibiotic therapy. Few hours later, the patient's condition worsened, he was lethargic and hypoactive with respiratory distress requiring mechanical ventilation and vasopressor support.

Fig. 1.

Photograph of the chest and extremities of the patient after 48h of hospital admission. There were multiple maculopapules symmetrically distributed over all the body. Also, were observed purpuric spots on nose, ears and feet.

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On hospital day 5, the blood cultures turned out positive for K. pneumoniae susceptible to meropem. Based on culture results, cefotaxime and amikacin were discontinued, and meropem initiated. He presented significant improvement after 72h.

Nosocomial infections with resistant Gram-negative organisms, particularly strains of K. pneumoniae, have become a significant problem.1 However, cutaneous manifestations are considered as atypical manifestations; Viswanathan et al.2 reported neonatal sepsis by K. pneumoniae associated with rash in seven children, and Kali et al.3 described the case of a newborn with sepsis and multiple pustules.