A 2-day-old male infant is evaluated in the neonatal intensive care unit after two episodes of
seizures. The patient was delivered via
vaginal delivery at 37-weeks gestational age. The mother received minimal
prenatal care and experienced a flu-like illness and
pharyngitis in the second trimester. Birth weight and head circumference are at the 20
th percentile. Temperature is 38.3°C (101°F),
blood pressure is 84/52 mmHg, and
pulse is 100/min. Physical examination is notable for
petechiae and
purpura over the arms, trunk, and legs. Abdominal examination reveals hepatosplenomegaly. Neuroimaging reveals the findings below. Which of the following additional physical examination findings is most likely present in this patient?
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