P485 Annular Skin Lesions in a Neonate –Trichophyton soudanense

Background Cutaneous fungal infections in healthy neonates are a very rare occurrence. We report a case of a previously well seventeen-day-old neonate presenting with a five-day history of multiple annular skin lesions. These were located on the neck, groin and scalp. Microbiological culture of skin scrapings confirmed the presence of trichophyton soudanense. Trichophyton soudanense is an anthrophilic dermatophyte endemic to sub-Saharan Africa, however it is now recognised as an emerging cause of dermatophytoses in the Western world - in our case Tinea Capitis and Tinea Corporis. Case Summary A seventeen-day-old neonate presented to our paediatric outpatient department with an annular skin rash. Five days previously lesions had been noted on the scalp and over subsequent days similar lesions appeared on the neck and groin. There were no associated symptoms and the baby was afebrile and had been feeding well. The patient’s mother was an African lady from Sierra Leone who had traveled to Ireland while pregnant at 35 weeks gestation. The baby was born at 40 weeks gestation via spontaneous vaginal delivery. The mother developed intra-partum pyrexia, investigations for sepsis were performed and she was commenced on intravenous antibiotics. The high vaginal swab was positive for Group B streptococcus and maternal CRP was105 mg/L. In light of the maternal history had a workup for sepsis performed and was commenced on intravenous antibiotics. Investigations were negative, antibiotics were discontinued and the baby was clinically well on discharge from the hospital. On routine attendance at POPD five days post delivery, the baby was clinically well with no evident skin lesions. The patient was referred to the POPD from his primary care provider. An annular rash was noted at the base of the neck, measuring 1.5 cm in diameter with central clearing. Similar lesions were noted on the scalp – which had associated circumferential pustular lesions, and in the groin – which had an erythematous base. Skin scrapings were sent for microbiological investigation. The skin scraping was incubated on potato dextrose and dermasel agar at 30° C. At five days isolates were identified based on distinctive colony morphology i.e. fluffy yellow colour growth and microscopic features as Trichophyton soudanense. Follow up Skin rash disappeared in ten days with residual hyperpigmentation which is typically seen in Trichophyton infections. Conclusion Though extremely rare, ringworm or tinea infection should be considered as differential diagnosis while dealing with annular lesions