An 11-day-old infant, who had been delivered at term via cesarean section, presents to the emergency department because of progressive diarrhea, poor feeding, and bilateral periorbital swelling and redness. His history includes eye discharge that developed at 2 days after birth and was treated with tobramycin eye drops. At 5 days of age, he had been brought to his pediatrician because of persistent eye discharge, a temperature of 102.2° (39°C), diarrhea, and poor feeding. A complete blood count at that visit revealed normal values and an elevated C-reactive protein value of 17 mg/L (1.7 mg/dL) (normal ≤12 mg/L [1.2 mg/dL]). He was started on oral rehydration solution and tobramycin/dexamethasone eye drops and given one dose of intramuscular cefuroxime.

On physical examination today, he is afebrile, lethargic, and grunting with a poor cry. He has normal fontanelles, bilateral periorbital swelling and redness, and small violaceous lesions over the upper and lower...

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