PMC7474776_01
(a) Skin ulcerations of face and ear. (b) Numerous tan-yellow lesions of the liver. (c) Annular lesions of the abdominal skin and denuded extremities.
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External examination revealed a well-developed, preterm female neonate with extensive skin sloughing and erythematous annular skin lesions with large portions of the body denuded (Figures 1(a) and 1(c)). The liver capsule was smooth and glistening but had innumerable tan-yellow, round lesions up to 0.2 cm in diameter on the capsular surface; similar lesions were disseminated in the parenchyma (Figure 1(b)).
Liver: (a) Cowdry bodies and cytologic changes consistent with herpes simplex virus infection (H&E, x600); (b) focus of infection (herpes simplex virus immunostain, x100). Cardiac papillary muscle: (c) foci of infection (herpes simplex virus immunostain, x100). Skin: (d) infection of hair follicle (herpes simplex virus immunostain, x100).
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The liver lesions revealed numerous areas of necrosis with large, multinucleate cells with margination and molding of their nuclei and Cowdry bodies that were immunopositive for HSV (using an HSV1/HSV2 antibody cocktail) (Figure 2(a)). The skin and myocardium had similar cytopathologic changes and necrosis (Figures 2(c) and 2(d)).