This neonate, born at 38 wks gestation, was delivered by urgent cesarian section for late decelerations. He was noted to have purpuric papules, patches and plaques in the delivery room, and disseminated intravascular coagulation was subsequently discovered on arrival in the nursery intensive care unit.. Bone marrow biopsy revealed myeloid maturation arrest. On day 5, a Grade IV intraventricular hemorrhage was discovered, and the patient ultimately progressed to brainstem herniation and death. Post-mortem examination revealed a diagnosis of congenital acute monoblastic leukemia with leukemic infiltration of the skin and multiple organs.
disseminated purpuric patches, papules and plaques