Interactive Quiz: Erythematous Eruption on a Newborn

Welcome to Rheumatology Consultant’s latest interactive diagnostic quiz. Over the next few pages, we’ll present a case and ask you to make the diagnosis and treat the patient. Along the way, we’ll provide details about the case, and at the end, we’ll share the patient’s outcome. Ready to get started? >> , First, let’s meet the patient… A 29-day-old girl was referred to a dermatology practice by a general pediatrics clinic after having been evaluated in the emergency department for a scattered erythematous eruption on her scalp, face, neck, legs, and abdomen for 4 days. The parents stated that prior to the eruption’s appearance, they had taken the newborn to the beach for the first time. The patient had been born via uncomplicated spontaneous vaginal delivery, and no rash had been noted at the time of birth. The mother denied any history of chronic medical conditions, specifically autoimmune conditions such as lupus. The mother reported that 18 months ago, prior to the delivery of her daughter, she had had an intrauterine fetal demise at approximately 36 weeks of gestation. Skin examination revealed erythematous plaques with a slightly atrophic and hyperpigmented central area scattered on the newborn’s scalp, periorbital area, face, and neck. Fewer small pink papules present on the abdomen and the lower extremities. There was no involvement of the genitals or mucosal membranes. What might be your next step?Perform a punch biopsyPrescribe a nonsteroidal anti-inflammatory drugConduct a genetic test Are you correct? >> , Answer: Perform a punch biopsy A punch biopsy was done of one of the scalp lesions and was stained with hematoxylin and eosin (Figure 3) as well as with colloidal iron (Figure 4). The biopsy revealed atrophic epidermis and interface dermatitis with positive staining for mucin. Based on the punch biopsy results, what is your diagnosis?Seborrheic dermatitisNeonatal acneNeonatal lupus erythematosus Are you correct? >> , Answer: Neonatal lupus erythematosus Findings suggested a diagnosis of neonatal lupus erythematosus (NLE). Results of a complete blood cell count and electrocardiography were normal. Clinically, NLE presents as nonscarring, slightly atrophic, annular or elliptical plaques that almost always occur on the face and scalp and at times on the trunk or extremities. NLE occurs in 1 in 12,500 to 1 in _____ live births.20,00080,000120,000 Are you correct? >> , Answer: 20,000 NLE occurs in 1 in 12,500 to 1 in 20,000 live births, predominantly affecting girls. The rash usually is not present at birth and appears weeks postpartum.  The rash generally disappears without any sequelae by approximately 6 months, corresponding with the clearance of maternal anti-Ro/SSA antibodies from the child’s circulation. And because the condition spontaneously resolves, treatment is usually unnecessary. The morbidity and mortality depend on the organ systems affected. Children who present only with cutaneous lesions have an excellent long-term prognosis. Which is the most commonly reported manifestation of NLE?VasculitisCardiac diseasePulmonary fibrosis Are you correct? >> , Answer: Cardiac disease  NLE encompasses an uncommon clinical spectrum of cutaneous, cardiac, hematologic, neurologic, hepatobiliary, or pulmonary abnormalities observed in newborns whose mother has an autoimmune disease such as systemic lupus erythematosus or Sjögren syndrome.  Extracutaneous disease is associated with higher morbidity rates. Cardiac disease is the most commonly reported manifestation, with third-degree atrioventricular block as the most common finding. To read the full case report, see: LeCourt AP, Dela Rosa KM. Erythematous papules and plaques on a newborn: a case of neonatal lupus erythematosus. Consultant. 2019;59(3):78-80. https://www.consultant360.com/exclusive/rheumatology/lupus/erythematous-papules-and-plaques-newborn-case-neonatal-lupus.