A neonate with vesicular scalp lesions
A baby was born via vaginal delivery at 41 weeks’ gestation to a 25-year-old primigravid with no known history of genital herpes simplex virus (HSV). Both parents reported previous oral HSV but no active lesions. Maternal history revealed a childhood varicella zoster virus (VZV) infection. Antenatal VZV titres were consistent with immunity. Integrated prenatal screen testing was declined. Membranes ruptured 8 h before delivery, with one documented maternal fever of 38.5°C. No genital HSV lesions were observed at delivery.
At birth, eight well-demarcated vesicles were noted over the right parieto-occipital region, each approximately 0.5 cm to 1 cm in diameter. Some were ruptured. Focal alopecia was noted at the site. The surrounding hair was darker and thicker than hair on the rest of the scalp. The baby was afebrile and clinically stable. A full septic workup was performed and antiviral medication initiated until an HSV infection was excluded....