An Unusual Presentation of Neonatal Cellulitis: Rapidly Progressing Bullous Lesion in a Newborn

Abstract

Bullous skin lesions presenting at birth are uncommon and may pose a diagnostic challenge, particularly when they are rapidly progressive and associated with systemic features. The differential diagnosis includes infectious, traumatic, and inherited blistering disorders. We report the case of a one-hour-old neonate who developed a unilateral bullous lesion involving the right foot shortly after wearing a sock, which was rapidly progressing with associated fever and well-demarcated erythema extending proximally to the mid-leg. No reported family history of similar lesions. The acute onset, rapid progression, surrounding erythema, and systemic manifestation raised concern for a serious neonatal cutaneous infection, while the temporal relationship with friction from the sock also necessitated consideration of trauma-related blistering disorders. The neonate was evaluated clinically and managed accordingly. A careful history of onset, preceding trauma, family history, systemic features, and evolution of the lesion is important for establishing the diagnosis and guiding early management of neonates with rapidly progressive bullous lesions.