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The birth weight was 2015 grams ( was missed in the antenatal USG. On examination, the child had no pallor, icterus, cyanosis, and edema, no dysmorphic features, eye examination was also normal. Skin had multiple well defined violaceous, non blanchable macules, and barely palpable plaques to nodules ranging in size from 0.3��0.3cm2 to 0.5��0.5 cm2, present all over the body including palms and soles, predominantly over face [Table/Fig-1]. [Table/Fig-1]: Blue berry muffin skin lesions Pan systolic murmur in 2nd, left intercostal space was present. Liver was 3cm palpable Cilengitide below the right costal margin, with firm consistency and sharp margin, Spleen: 1.5 cm palpable below the left costal margin. Complete blood count revealed severe thrombocytopenia (17,000). First sepsis screen was negative, second sepsis screen was positive. Coagulation study was deranged. Prothrombin Time was 21.3 (against normal of 11.7) and Partial Thromboplastin Time was >180 (normal 30). Chest X-ray showed cardiomegaly with infiltrates. Infantogram showed extensive metaphysitis predominantly involving long bones [Table/Fig-2]. [Table/Fig-2]: learn more Infantogram showing growth plate irregularity Various differentials for trans-placental acquired dermatosis include infectious, neoplastic and inflammatory causes. Reasons favoring infectious cause in this case included a low birth weight, small for gestational age child with microcephaly, hepatosplenomegaly, thrombocytopenia with skin rash and metaphysitis. So, we had a term 37-week-child, with early onset sepsis, pneumonitis with acynotic congenital heart disease with thrombocytopenia, hepatosplenomegaly, coagulopathy with transplacentally http://www.selleckchem.com/products/ci994-tacedinaline.html acquired dermatosis and the differentials for this included various intrauterine infections- congenital rubella syndrome (CRS), congenital Cytomegalo Virus Infection(CMV), congenital toxoplasmosis, early syphilis, hemolytic disease of newborn. Further workup for the diagnosis showed Rubella serology of baby as IgM =1.98 (