An 11-day-old full-term Hispanic male presented with a one-day history of lethargy, jaundice, fever, and melena. Birth history was significant for induction of labor at 37 weeks gestation secondary to pre-ecclampsia and birth weight in the tenth percentile (2.20 kg). Upon admission, blood and CSF cultures were drawn, and antibiotics were administered. TORCH titers were negative. After 48 hours, bacterial and fungal cultures were negative, but viral culture was positive for rotavirus; therefore, antibiotics were discontinued. The patient's symptoms resolved.  On the afternoon of planned discharge, however, the patient had an acute onset of nasal and oral hemorrhage. The patient was stabilized but became bradycardic with episodes of desaturations. Despite resuscitative efforts, the patient expired.

A complete autopsy was performed. Pertinent negative findings at autopsy included the absence of mucocutaneous lesions. Gross examination of the internal organs failed to identify a source of gastrointestinal hemorrhage. The liver, however, contained diffuse tan miliary lesions surrounded by dark red hemorrhagic tissue on cut section (Figure 1). Microscopic examination of the liver demonstrated marked necrosis with few areas of remaining viable hepatocytes (Figure 2). Intranuclear inclusion bodies were also identified throughout the specimen (Figure 3). Sections from the adrenal glands and spleen contained areas of infarct, but no inclusion bodies were identified.

LABORATORY DATA

TORCH Titers:

• T. Gondii IgG - 0 IU/mL (>12 positive)
• Rubella IgG - 48.4 IU/mL (>9.9 positive)
• CMV IgG - 2.95 IU/mL (>1.10 positive)
• HSV I IgG - 0.29 IU/mL (>1.10 positive)
• HSV II IgG - 0.50 IU/mL (>1.10 positive)

ANCILLARY STUDIES
Noncontributory.

Figure 1:	Figure 2:	Figure 3:

GROSS PATHOLOGY
Figure 1 is a gross photograph of a cut surface of the liver with tan punctate areas of hepatic tissue surrounded by hemorrhagic, necrotic liver tissue.

MICROSCOPIC PATHOLOGY
Figure 2 is a low-power photomicrograph of the liver showing hemorrhagic necrosis. Figure 3 is a high-power photomicrograph of the liver showing necrosis and hepatocytes containing nuclear inclusion bodies.