Fulminant Skin Abscesses and Hepatic Failure: A Notorious Disease Hidden in Plain Sight

We present a one-month-old male brought in with diffuse large skin abscesses, failure to thrive, and hepatic failure. His status depreciated rapidly, requiring intensive care unit admission as a result of septic shock and multiple incision and drainage surgeries for skin abscesses. Wound site cultures yielded Staphylococcus aureus and urine culture positive for Candida albicans; however, extensive further investigations for causative infectious versus immune-related etiologies remained unfruitful. Despite broad-spectrum antibiotic, antifungal, and antituberculosis coverage, the child’s condition deteriorated further. Within a month of admission, parents were informed of an abnormal neonatal screening report from the hospital where he was born, as presumptively positive for galactosemia. Feeds were immediately shifted to non-lactose formulation, and diagnosis was then confirmed via genetic testing. Jaundice, coagulopathy, inflammatory markers, and weight gain all steadily improved thereafter, and the child was repatriated for continuity of care. Our case demonstrates a unique disease manifestation of a well-known, often forgotten disorder and reemphasizes the importance of rapid institution of lactose-free formula milk.