CASE
A full-term baby boy was born to a 19-year-old gravida 1, para 1 mother via vaginal delivery at 38 weeks' gestation. Decelerations in the baby's heart rate prompted some concern, but the infant's Apgar scores were 9 at 1 minute and 9 at 5 minutes.
The infant was in no acute distress; vital signs were within normal limits. Anterior and posterior fontanelles were open and flat with sutures approximated and moist mucous membranes. Thoracic and abdominal examinations were unremarkable. Newborn reflexes were normal. The baby moved all extremities equally and vigorously. There was no evidence of seizure activity or increased intracranial pressure. A large pigmented plaque with dark hair extended from the nape of the neck to the upper arms and down to the lower torso in a bathing suit distribution (see Figure 1). Also of note were multiple satellite pigmented papules and nodules ranging in diameter from 0.3 cm to 1 cm on the buttocks and extremities. The lesions were rough to palpation, and most were of uniform color; hair was present in some lesions on the extremities.
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