Case 2: Herpes Simplex Virus Infection in a Preterm Infant and Complications

This preterm infant is the product of a dichorionic, diamniotic twin pregnancy born at 27 5/7 weeks’ gestation to a 22-year-old woman via an emergency cesarean delivery for an abnormal fetal heartbeat. The woman’s pregnancy was complicated with prolonged rupture of membranes 8 days before delivery, gestational diabetes mellitus, and a history of depression. She denies a history of sexually transmitted infections, including herpes simplex virus (HSV). She received ampicillin, amoxicillin, and azithromycin as well as 2 doses of betamethasone before delivery. The male infant has Apgar scores of 3, 4, and 8 at 1, 5, and 10 minutes after birth, respectively. An endotracheal tube is placed 4 minutes after birth, and the infant is admitted to the NICU. He receives 1 dose of surfactant and is in stable condition with noninvasive ventilation. The infant receives ampicillin and gentamicin for 7 days for presumed sepsis. His complete blood cell count and C-reactive protein are within normal limits, with a negative initial blood culture. His screening head ultrasonography result is negative for intraventricular hemorrhage on day 7 after birth. At 9 days of age, the infant develops respiratory distress and a diffuse vesicular rash on his axilla, neck, back, and chest. Cerebrospinal fluid (CSF) analysis reveals a white blood cell count of 54/μL (0.5×109/L), red blood cell count …