Neonatal lupus

Neonatal lupusA 20 days old, otherwise healthy boy, presented with multiple erythematous annular rashes involving his scalp, neck, trunk and four extremities.The truncal lesions had been present for 1.5 weeks, and the scalp and neck lesions were noted 2 days before the presentation.The eruption was asymptomatic without itching or discomfort told by his mother.His mother was healthy but tested positive for autoantibodies.His laboratory tests were mainly unremarkable except for positive anti-SSA/Ro and anti-SSB/La being >240 and >320 EliAU/ml (normal range < 7 EliAU/ml), respectively.The diagnosis of neonatal lupus (NL) was confirmed.Electrocardiography found no evidence of congenital heart block.The rash improved with topical corticosteroids and sun avoidance.By the time, the patient was 6 months old, the rash had resolved, and there were no abnormal levels of hemoglobin, platelets and liver enzymes (Figure 1).NL is an acquired condition that occurs in 20 000 neonates born to mothers with autoimmune diseases who pass IgG autoantibodies through transplacental route. 1,2About half of the mothers of affected infants are asymptomatic at the time of delivery, despite having antibodies, usually anti-SSA/Ro (95%), anti-SSB/La and less frequently anti-U1RNP. 3The most common clinical findings of NL are cutaneous manifestations (50-70%), transient anemia and rarely, complete heart block. 4The rash is noted at birth in few cases, and many affected children will not develop a rash until after exposure to UV light.The rash is usually comprised of erythematous annular lesions with slight central atrophy and raised margins, most commonly localized on sun-exposed areas, particularly on the head and neck, less commonly on the trunk and extremities. 1,5Most infants with NL have transient disease course that spontaneously resolves.Except for the cardiac manifestations that require sophisticated monitoring, NL usually is self-limited and resolves by age 3-6 months. 2,