The “blueberry muffin” baby has a skin rash with scattered violaceous lesions. The distribution is reminiscent of blueberries in a blueberry muffin. This may occur due to a wide range of conditions.


The lesions may range from small macules to papules with colors ranging from blue to purple to red.


The classic case involves a chronic anemia with the lesions representing foci of extramedullary hematopoiesis. This can be seen with:

(1) hemolytic disease of the newborn

(2) TORCH infections (toxoplasmosis, rubella, cytomegalovirus, herpes)

(3) twin-twin transfusion syndrome

(4) other hematologic disorders


A variety of tumors can also present with violaceous skin lesions:

(1) acute leukemia

(2) Langerhans cell histiocytosis (LCH)

(3) reversible histioocytosis

(4) vascular malformations or tumors

(5) neonatal lupus erythematosus

(6) Ewing sarcoma

(7) neuroblastoma

(8) alveolar rhabdomyosarcoma


The workup will depend on the clinical situation. Sometimes a biopsy or examination of the blood smear will be diagnostic. In the event of metastatic sarcoma the workup may be complex.


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