We present a full-term female infant with congenital candidiasis
characterized by extensive vesicular and pustular skin lesions associated
with pneumonia and severe respiratory distress that appeared during the
first hours after birth. The patient was born by cesarean section with no
history of rupture of membranes. The mother had a vaginal discharge 3
weeks before delivery. The diagnosis was made by culture of pustular fluid,
which grew Candida albicans. Systemic cultures were negative. The infant
required a very brief course of conventional mechanical ventilation in spite
of impressive and extensive lung infiltrates on the chest radiograph. She
made a very quick clinical recovery although it is remarkable that
antifungal treatment with amphotericin B was begun very late in her
clinical course at the time when she was showing obvious signs of major
improvement. Current management guidelines strongly recommend specific
therapy for infants with invasive congenital candidiasis or with burn-like
extensive dermatitis even without lung involvement. We are not suggesting
any change in these recommendations; however, at least in our patient,
when amphotericin B was started, she was clearly recovering; it seems
possible that her disease although extensive might have experienced an
unusual spontaneous regression. This case can provide further insights into
this unusual neonatal infection.