Mariana Silva Duarte1, Filomena Pinto2, Rodrigo Carvalho3, Marta Conde4
1Medical Paediatric Unit, Área de Pediatria, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central – EPE, Lisbon, Portugal, 2Neonatal Intensive Care Unit, Área de Pediatria, Maternidade Alfredo da Costa, Centro Hospitalar de Lisboa Central – EPE, Lisbon, Portugal, 3Dermatology Department, Hospital dos Capuchos, Centro Hospitalar de Lisboa Central – EPE, Lisbon, Portugal, 4Pediatric Rheumatology Unit, Área de Pediatria, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central – EPE, Lisboa, Portugal
Address for Correspondence: Mariana Duarte, Rua Jacinta Marto, 1169-045 Lisboa, Portugal
Email: marianaduarte@campus.ul.pt
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Question :We describe a case of a female newborn, from mother with systemic lupus erythematosus (SLE), with onset of skin lesions since day seven of life. Examination revealed six annular, erythematous, scaly patches on the face, trunk and lower extremities (Figures 1 and 2). Laboratory tests showed hemoglobin 9.6 g/dL, leukocytes 8.77 x109/L, platelets 239x109/L, ANA >1/640 and positive extractable nuclear antigens (ENAs) (anti-Ro/SSA, anti-La/SSB and RNP/Sm). Cardiologic evaluation didn’t reveal anomalies. Skin biopsy showed apoptotic keratocytes with hydropic degeneration of the basal epidermis and perivascular lymphocytic infiltrate of the dermis compatible with neonatal lupus (NLE). Low potency topical corticosteroids (LPTC) were started.
Because of skin worsening (Figure 3), liver enzymes elevation (AST 225 U/L, ALT 87 U/L), and thrombocytopenia (115x109/L), low-dose systemic corticosteroids (SC) were started. Progressive reduction of SC until discontinuance was possible with normalization of the laboratory results and skin remission.
Figure 1. Scaly patches on the face. 
Figure 2. Scaly patches on the trunk and lower extremities. 
Figure 3. Skin worsening.  What is the diagnosis?
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