Eye Discharge in a 9-day-old Twin Boy.

1. Eleanor A. Sharp, MD* 2. Jessica L. Garrison, MD* 1. *Paul C. Gaffney Division of Pediatric Hospital Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA A 9-day-old infant boy presents to the emergency department with a 1-day history of bilateral eye redness and yellow discharge. The morning before presentation, his mother noted his right eye to be crusted shut with dried yellow discharge. She applied a warm compress that removed the discharge and allowed him to open his eye normally. However, over the next several hours he developed bilateral eyelid swelling and yellow drainage from both eyes. He seemed to be trying to rub his eyes and was fussier than usual. The day of presentation, his mother noted both his eyes were red, swollen, and draining yellow fluid, so she brought him to the emergency department for evaluation. The patient has not been breastfeeding as long or as frequently as usual over the past day but has still had normal stool and urine output. The patient has not had fever, nasal congestion, rhinorrhea, rash, or sick contacts. His twin sister is asymptomatic. The patient was born full term via spontaneous vaginal delivery. He was the firstborn twin. The mother received routine prenatal care, and both the pregnancy and delivery were uncomplicated. Maternal screening for gonorrhea and chlamydia at the first prenatal visit was negative, and the patient received ophthalmic erythromycin after delivery. In the emergency department, the infant is afebrile with normal vital signs for age. He is fussy but consolable. He has periorbital swelling with overlying erythema, conjunctival injection, and mucopurulent discharge from both eyes, right worse than left. The reminder of his examination is unremarkable. Due to his age, evaluation for possible serious bacterial infection is completed. His white blood cell count is …