Invasive fungal dermatitis in a 770 gram neonate

A 770 g birthweight, 25-weeks gestation infant girl was born from a bigeminal pregnancy. Six days later she developed erythematous "diaper dermatitis" and maceration of the flexural areas. Despite topical antifungal therapy, erythematous plaques appeared 2 days later on the back. Within less than 24 hours, skin erosions with crusting appeared and spread over the whole body. Candida albicans was found in cutaneous scales, and blood, umbilical catheter, and cerebrospinal fluid cultures. In spite of intravenous fluconazole therapy, her general condition deteriorated and she died 2 days later. This premature neonate had a typical case of invasive fungal dermatitis, which is characterized by diffuse erosive and crusting cutaneous lesions appearing several days after birth and a high rate of systemic fungal infection (mainly but not exclusively) due to Candida sp. Mortality is high and prompt diagnosis and initiation of antifungal therapy appears to be the most important factor for survival.