A full-term male neonate presents with multiple bullous and erythematous skin lesions at birth (Figs 1–4).

Following birth, bacterial and fungal skin and blood cultures as well as serum and wound herpes simplex virus (HSV) polymerase chain reaction (PCR) tests were performed. Empiric intravenous ampicillin, gentamicin, and acyclovir were started and the infant was transferred to our tertiary-care NICU for further evaluation and management of the skin lesions.

Soon after birth, wound care was provided based on pediatric dermatology recommendations and included generous petroleum jelly–based gauze application underneath stockinette dressings, bathing techniques, and draining of blisters.

On day 1, the patient was noted to have a low resting heart rate. Electrocardiography (EKG) revealed a prolonged QTc of 506 milliseconds. Echocardiography demonstrated a small patent foramen ovale with left-to-right shunting. Serial EKG and monitoring for hemodynamic instability via continuous telemetry, pulse oximetry, and blood pressure measurements were...

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