This week’s case involved an afebrile well-appearing infant presenting with a pustular rash and a scalp abscess. The differential for the pustular rash included benign neonatal pustular melanosis, a common and self-limiting condition in neonates, however given the scalp abscess other bacterial skin infections could not be excluded. Although the infant was afebrile, all learners felt initial screening labs to assess for potential infection or sepsis was warranted.

Point-of-care ultrasound (POCUS) revealed a subcutaneous scalp abscess. Laboratory workup demonstrated leukocytosis but a normal procalcitonin level. Given these findings, the team debated the necessity of lumbar puncture (LP) and empiric antibiotics. The consensus leaned toward using antibiotics to treat the soft tissue infection rather than initiating meningitic coverage, as an LP was not deemed necessary in the absence of fever.

Ultimately, wound cultures from the skin pustules grew Staphylococcus aureus. The abscess responded well to antibiotics and no incision and drainage (I&D) was required. This case emphasized the importance of a collaborative discussion with the hospitalist team regarding the need for further workup or admission, highlighting a patient-centered, multidisciplinary approach.