Case Report in NEJM: Cutaneous Eruption in a pregnant woman
A 23-year-old pregnant woman (G3 P0 A2) presented at 23 weeks and 3 days of gestation with a 3-day history of fever, widespread pruritic rash, and sore throat, which were followed by myalgias and joint pain 2 days later. Both the patient and her partner reported no travel outside the United States for the past 2 years.

Findings from physical examination were pertinent for erythematous follicular macules and papules on the trunk and arms, scattered tender pink papules on the palms, and a few petechiae on the hard palate; neither conjunctivitis nor lymphadenopathy was present

Histopathological examination of lesional skin revealed a mild perivascular lymphocytic infiltration in the upper dermis, admixed with some neutrophils.

ZIKV RNA was detected in both urine and serum specimens with the use of reverse-transcriptase polymerase chain reaction (RT-PCR)

Findings from fetal ultrasonography performed on the day of presentation showed an estimated fetal weight of 644 g (53rd percentile), an estimated head circumference of 221 mm (63rd percentile), and normal intracranial anatomy. Fevers and rash subsided after the patient received 3 days of supportive care. Serial fetal ultrasonography revealed no abnormalities ante partum.

A full-term infant weighing 2990 g was delivered vaginally. Neonatal USG and MRI Head showed a normal head size and intracranial anatomy, with no calcifications. The patient declined amniocentesis; therefore, in utero testing of the fetus was not performed. RT-PCR assay in placental tissue sample was negative for ZIKV, and the results from remaining neonatal laboratory testing revealed no evidence of ZIKV infection.

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