A 6-week-old infant develops vesicles and pustules on a background of erythema, distributed on the cheeks and trunk. Gram stain of a pustule shows Gram-positive cocci in clusters. This is most consistent with:

• A Erythema toxicum neonatorum
• B Neonatal pustular melanosis
• C Staphylococcal impetigo neonatorum ✓
• D Miliaria pustulosa

Explanation

Staphylococcal impetigo neonatorum (bullous impetigo in neonates) caused by Staphylococcus aureus (phage group 2 exfoliative toxin-producing strains) presents with vesiculopustular eruptions with Gram-positive cocci in clusters on culture/smear. It can progress to staphylococcal scalded skin syndrome (SSSS) at this age. Erythema toxicum neonatorum appears within first 72 hours of life; Gram stain shows eosinophils (not bacteria). Neonatal pustular melanosis is present at birth, shows melanin-containing non-infective pustules. Miliaria pustulosa occurs due to sweat duct obstruction in hot environments. A 6-week-old with Gram-positive cocci confirms bacterial etiology requiring systemic anti-staphylococcal antibiotics.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.