case_images: PMC5697754_01
case_images: Day 1: after removal of the IV line, the dorsum of the right hand became pale and necrotic (A) and bullae, tender erythema, and edematous bruising was present and spreading on the right mid-humerus and axilla (B), potentially suggesting compromised blood supply. Diphenhydramine, acetaminophen, ibuprofen and lidocaine therapy was initiated. Pulse and compartment pressures were stable, prompting conservative management. Day 2: The dorsal non-blanching area resolved and erythema did not spread past the antecubital region (C) but bullae persisted alongside sloughing of skin (D). The patient was discharged on Day 3 with placements of occlusive dressings and a scheduled follow-up visit. Day 7: Bullae and erythema was markedly reduced on both the mid-humerus (E) and dorsum of hand (F), and the infant showed improved movement of the right arm.
case_images: nihms905848f1.jpg
case_images: PMC5697754_01_nihms905848f1.jpg
case_images: F1
case_images: Furthermore, a large white lesion in the center of the dorsum of the right hand with surrounding deep purple bruising was noted concerning for necrosis (Figure 1). By the following morning, the non-blanching white area had resolved, bullae were still visible, and the patient appeared to be improving (Figure 1). The plastics team recommended Vaseline with Xeroform changes (Figure 1). 11 days after discharge, the parents reported continued improvement and increasing ROM in patient's right arm (Figure 1). Follow-up at 5 weeks showed continual improvement, but not complete return to baseline (Figure 1).