A female newborn was admitted to the neonatal intensive care unit of an academic medical center due to ulcerative skin lesions and areas of bluish discoloration involving the trunk, extremities, face, palms, and soles. The patient was born vaginally at 33 weeks’ gestation to a 40-year-old woman (gravida 6 para 3) whose pregnancy was complicated by preterm premature rupture of membranes and gestational diabetes. Maternal screening results for hepatitis B virus surface antigen, HIV antibodies and p24 antigen, syphilis (rapid plasma reagin test), and group B Streptococcus were negative. The mother tested as nonimmune for rubella and reported no recent history of travel outside the USA.