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The main clinical manifestation of human herpesvirus 6 is exanthema subitum (also known as roseola infantum) and febrile syndrome. Central nervous system manifestations are not unusual in herpesvirus 6 infection, and even though the pathophysiology is not clear, they need to be early diagnosed and treated in order to avoid potentially serious damage. We present the case of an immunocompetent 2-year-old girl with encephalitis as a complication of herpesvirus 6 infection. We want to emphasize the significance of an early diagnosis and treatment in order to prevent further complications due to the central nervous system extension.

Presentación de casos clínicos RESUMENLa hipotermia terapéutica constituye el tratamiento de elección para los recién nacidos con encefalopatía hipóxico-isquémica moderada-grave, que cambia el pronóstico de estos niños y se acepta como una técnica segura y con escasas complicaciones secundarias considerando su beneficio. Un posible efecto adverso es la necrosis grasa subcutánea, una paniculitis transitoria aguda de presentación durante las primeras semanas de vida. Se presenta un caso de un recién nacido a término afecto de encefalopatía hipóxico-isquémica con lesiones cutáneas en forma de eritema multiforme generalizado y placas eritematosas firmes e induradas en la espalda, los glúteos y las extremidades a los 12 días de vida, tras el tratamiento con hipotermia. El estudio histopatológico, tras la biopsia cutánea, confirmó la sospecha de necrosis grasa subcutánea. Al mes de vida, presentó cifras elevadas de calcio sérico, que precisaron tratamiento con hidratación intravenosa y diuréticos. La calcemia descendió hasta normalizarse a los 3 meses, con desaparición progresiva de las lesiones cutáneas. Palabras clave: recién nacido, encefalopatía hipóxico-isquémica, hipotermia inducida, necrosis grasa subcutánea, hipercalcemia. ABSTRACTTherapeutic hypothermia is the current standard treatment in newborns with moderate to severe hypoxic-ischemic encephalopathy, changing the outcome of these children. It is considered a safe technique with almost no side effects. A possible adverse side event is subcutaneous fat necrosis, which is an acute self-limiting panniculitis that develops during the first weeks of life. We report a case of a newborn at term suffering hypoxic-ischemic encephalopathy with a generalized multiform erythematous rash and firm and indurated plaques over the back, buttocks and extremities on his 12 th day of life after being treated with therapeutic hypothermia. Histopathological study after skin punch biopsy confirmed the suspicion of subcutaneous fat necrosis. The infant developed asymptomatic moderate hypercalcaemia within the first month of life, which was Necrosis grasa subcutánea con hipercalcemia persistente en un neonato tratado con hipotermia terapéutica. Reporte de un caso Subcutaneous fat necrosis and persistent hypercalcaemia in a newborn treated with therapeutic neonatal hypothermia. A case report treated with intravenous fluids and diuretics. Serum calcium levels decreased and normalized in 3 months, with progressive disappearance of skin lesions.

We present the case of a six-year-old boy who was attended at primary care center due to fever and two scabby lesions, one on the scalp and the other on the trunk, as well as cervicaloccipital lymphadenopathies, after a tick bite 24 hours ago. The initial diagnosis is rickettsiosis, specifically of TIBOLA, which, after the appearance of a generalized palmar and plantar rash, was changed to Mediterranean spotted fever (MBF). However, serology for Rickettsia conorii was negative but the eschar PCR (polymerase chain reaction) was positive for Rickettsia sibirica, the most common producer of FBM associated with lymphangitis or «like» FBM. After treatment with azithromycin, fever disappeared within 48 hours and more progressive, of skin lesions and lymphadenopathy over 20 days later.

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