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Fu C, Sun W, Peng H, Zhu X. Neonatal lupus erythematosus as a rare trigger of gastrointestinal involvement in neonates. Sci Rep 2024; 14:3791. [PMID: 38360914 PMCID: PMC10869832 DOI: 10.1038/s41598-024-54091-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 02/08/2024] [Indexed: 02/17/2024] Open
Abstract
Cutaneous and cardiac involvement in neonatal lupus erythematosus (NLE) has been extensively studied; however, gastrointestinal system involvement (GSI) remains unexplored. This study aimed to investigate the clinical features of GSI in patients with NLE with a particular focus on feeding intolerance (FI) and diarrhea. We conducted a retrospective analysis of the clinical data of patients diagnosed with NLE at the Children's Hospital of Soochow University between 2011 and 2022. In this study, of 39 patients diagnosed with NLE, 27 presented with GSI. 9 patients who presented with FI or diarrhea as the primary manifestation were positive for anti-SSA antibody, and 5 were dual positive for anti-SSA and anti-SSB antibodies. Among the mothers of the NLE patients with GSI, 18 had systemic lupus erythematosus, 3 had Sjogren's syndrome, 2 had mixed connective tissue disease, and one each had autoantibody abnormalities and photosensitivity symptoms; 4 mothers denied having any autoimmune disease. In this study, 69.23% of patients with NLE exhibited GSI, which was linked to hypocomplementemia and anti-SSA antibodies. Thus, clinicians should remain vigilant for NLE in neonates, particularly when accompanied with rash and other organ dysfunction and when the high-risk factors of FI and diarrhea have been excluded.
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Affiliation(s)
- Changchang Fu
- Department of Neonatology, Children's Hospital of Soochow University, Suzhou, 215000, China
| | - Wenqiang Sun
- Department of Neonatology, Children's Hospital of Soochow University, Suzhou, 215000, China
| | - Hanghang Peng
- Department of Neonatology, Children's Hospital of Soochow University, Suzhou, 215000, China
| | - Xueping Zhu
- Department of Neonatology, Children's Hospital of Soochow University, Suzhou, 215000, China.
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Alfalasi M, ElGhazali G, Fathalla W, Khawaja K. Anti-U1RNP-70kD-positive case of neonatal lupus presenting with seizure and incomplete heart block: a case report and literature review. Front Pediatr 2023; 11:1239327. [PMID: 37681197 PMCID: PMC10482031 DOI: 10.3389/fped.2023.1239327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/04/2023] [Indexed: 09/09/2023] Open
Abstract
Neonatal lupus erythematosus (NLE) is an autoimmune disease caused by the transplacental passage of anti-Ro/SS-A and anti-La/SS-B. This can be less commonly seen with U1-ribonucleoprotein (U1RNP). Our patient is a 7-day-old male, who first presented with seizures. In addition, during an electroencephalogram, he was found to have an irregular heart rhythm. Looking further into the history, we found that the mother was aware that she had systemic lupus erythematosus (SLE). However, she had not been followed up with a rheumatologist. The workup for NLE found a negative anti-Ro/SS-A and anti-La/SS-B, with a positive U1RNP-70kD. U1RNP-70kD is a diagnostic test for mixed connective tissue disease in adults, but no research has been done on its significance in NLE. Despite having SLE, the infant's mother did not receive surveillance during her pregnancy, as the current guidelines are tailored for mothers with anti-Ro/SS-A and anti-La/SS-B. As a result, this calls for the extension of these guidelines to include the U1RNP-70kD antibody. In this case, the 70kD subtype of U1RNP was positive, which may have had a role to play in this unusual presentation. However, further research is needed to improve the care of mothers and babies with U1RNP-70kD.
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Affiliation(s)
- Maryam Alfalasi
- Education Institute, Sheikh Khalifa Medical City (SKMC), Abu Dhabi, United Arab Emirates
| | - Gehad ElGhazali
- Sheikh Khalifa Medical City(SKMC), Purelab-Purehealth, Abu Dhabi, United Arab Emirates
- College of Medicine and Health Sciences, United Arab Emirates University (UAEU), Al Ain, United Arab Emirates
| | - Waseem Fathalla
- Department of Pediatric Neurology, Sheikh Shakhbout Medical City (SSMC), Abu Dhabi, United Arab Emirates
| | - Khulood Khawaja
- Department of Pediatric Rheumatology, Sheikh Shakhbout Medical City (SSMC), Abu Dhabi, United Arab Emirates
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Mooney C, Shah M, Mukherjee G. Rash, Anemia, and Thrombocytopenia in a 6-week-old Boy. Pediatr Rev 2021; 42:558-561. [PMID: 34599055 DOI: 10.1542/pir.2020-000265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | - Meera Shah
- Emory University/Children's Healthcare of Atlanta, Atlanta, GA
| | - Gargi Mukherjee
- Emory University/Children's Healthcare of Atlanta, Atlanta, GA
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Song JY, Park SE, Byun JH, Lee N, Han YM, Byun SY, Kim SH. Neonatal Lupus Erythematosus as a Rare Cause of Fever in Young Infants. J Clin Med 2021; 10:jcm10143195. [PMID: 34300361 PMCID: PMC8306892 DOI: 10.3390/jcm10143195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/29/2021] [Accepted: 07/16/2021] [Indexed: 11/16/2022] Open
Abstract
Neonatal lupus erythematosus (NLE) is a rare disease caused by passively transmitted autoantibodies from the mother. NLE is a multi-organ system disease characterized by cutaneous, cardiac, hematological, hepatobiliary, and neurological manifestations. This study aimed to review the various symptoms and clinical manifestations in young infants with NLE and their mothers. We conducted a retrospective review of medical records of patients with NLE who were both examined and treated at Pusan National University Children's Hospital between January 2009 and December 2020 and their mothers. Twenty-seven patients with NLE comprising 13 male patients (48.1%) and 14 female patients (51.9%) were included. The most common symptom was rash (40.7%), followed by fever (25.9%), arrhythmia (14.8%), splenomegaly (11.1%), and intrauterine growth retardation (7.4%). Seven patients with fever had various organ system manifestations, including cutaneous (100%), hematological (71.4%), hepatobiliary (57.1%), and central nervous system (CNS; 28.6%) manifestations. Two of the febrile patients had aseptic meningitis. Cutaneous, cardiac, hematological, hepatobiliary, and CNS involvement were noted in 44.4%, 18.5%, 51.9%, 40.7%, and 22.2% of the patients, respectively. Systemic lupus erythematosus (SLE) was the most common maternal disease (14/27, 51.9%). Ten mothers (37.0%) had not been diagnosed with any autoimmune disease until their babies were diagnosed. Among them, three were subsequently diagnosed with SLE, five were diagnosed with the Sjögren's syndrome, and two of them still had no known diagnosis of any autoimmune disorder. Fever is a common symptom of NLE; thus, when there is no clear focus of fever in infants, NLE needs to be considered, especially in cases with skin rashes.
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Affiliation(s)
- Ji Yeon Song
- Department of Pediatrics, Pusan National University Children’s Hospital, Yangsan 50612, Korea; (J.Y.S.); (S.E.P.); (J.-H.B.); (N.L.); (Y.M.H.); (S.Y.B.)
| | - Su Eun Park
- Department of Pediatrics, Pusan National University Children’s Hospital, Yangsan 50612, Korea; (J.Y.S.); (S.E.P.); (J.-H.B.); (N.L.); (Y.M.H.); (S.Y.B.)
| | - Joung-Hee Byun
- Department of Pediatrics, Pusan National University Children’s Hospital, Yangsan 50612, Korea; (J.Y.S.); (S.E.P.); (J.-H.B.); (N.L.); (Y.M.H.); (S.Y.B.)
| | - Narae Lee
- Department of Pediatrics, Pusan National University Children’s Hospital, Yangsan 50612, Korea; (J.Y.S.); (S.E.P.); (J.-H.B.); (N.L.); (Y.M.H.); (S.Y.B.)
| | - Young Mi Han
- Department of Pediatrics, Pusan National University Children’s Hospital, Yangsan 50612, Korea; (J.Y.S.); (S.E.P.); (J.-H.B.); (N.L.); (Y.M.H.); (S.Y.B.)
| | - Shin Yun Byun
- Department of Pediatrics, Pusan National University Children’s Hospital, Yangsan 50612, Korea; (J.Y.S.); (S.E.P.); (J.-H.B.); (N.L.); (Y.M.H.); (S.Y.B.)
| | - Seong Heon Kim
- Department of Pediatrics, Seoul National University Children’s Hospital & College of Medicine, Seoul 03080, Korea
- Correspondence: ; Tel.: +82-2-2072-4304
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Vanoni F, Lava SAG, Fossali EF, Cavalli R, Simonetti GD, Bianchetti MG, Bozzini MA, Agostoni C, Milani GP. Neonatal Systemic Lupus Erythematosus Syndrome: a Comprehensive Review. Clin Rev Allergy Immunol 2017; 53:469-476. [DOI: 10.1007/s12016-017-8653-0] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Abstract
Neonatal lupus results from the passive transfer of autoantibodies; however, this transfer is not sufficient to cause disease. This article reviews clinical presentation with a focus on autoimmune-mediated congenital heart disease. Recent data looking for additional disease mechanisms and biomarkers as well as latest information on interventions will be reviewed. Our understanding of this rare disease is often dependent on patient participation in disease registries and biorepositories. Future participation in registries including descriptive as well as biophysical data is critical to our knowledge.
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Affiliation(s)
- Marisa S Klein-Gitelman
- Division of Rheumatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 E. Chicago Avenue, # 50, Chicago, IL, 60611, USA.
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Hwang JK, Park HK, Sung YK, Hoh JK, Lee HJ. Maternal outcomes and follow-up of preterm and term neonates born to mothers with systemic lupus erythematosus. J Matern Fetal Neonatal Med 2017; 31:7-13. [DOI: 10.1080/14767058.2016.1205027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Jae-Kyoon Hwang
- Department of Pediatrics, Hanyang University Hospital for Rheumatic Diseases Clinical Research Center for Rheumatoid Arthritis, Seoul, Republic of Korea
| | - Hyun-Kyung Park
- Department of Pediatrics, Hanyang University Hospital for Rheumatic Diseases Clinical Research Center for Rheumatoid Arthritis, Seoul, Republic of Korea
| | | | - Jeong-Kyu Hoh
- Department of Obstetrics and Gynecology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Hyun Ju Lee
- Department of Pediatrics, Hanyang University Hospital for Rheumatic Diseases Clinical Research Center for Rheumatoid Arthritis, Seoul, Republic of Korea
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Yousef Yengej FA, van Royen-Kerkhof A, Derksen RH, Fritsch-Stork RD. The development of offspring from mothers with systemic lupus erythematosus. A systematic review. Autoimmun Rev 2017; 16:701-711. [DOI: 10.1016/j.autrev.2017.05.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 03/31/2017] [Indexed: 01/14/2023]
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Neonatal lupus: Follow-up in infants with anti -SSA/Ro antibodies and review of the literature. Autoimmun Rev 2017; 16:427-432. [DOI: 10.1016/j.autrev.2017.02.010] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 02/12/2017] [Indexed: 11/20/2022]
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Bason C, Pagnini I, Brucato A, Maestroni S, Puccetti A, Lunardi C, Cimaz R. Congenital heart block and immune mediated sensorineural hearing loss: possible cross reactivity of immune response. Lupus 2016; 26:835-840. [PMID: 27913750 DOI: 10.1177/0961203316682099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Immune-mediated sensorineural hearing loss may complicate systemic autoimmune diseases. We have previously reported the presence of antibodies directed against inner ear antigens in patients with Cogan syndrome, a disease characterized by sudden hearing loss and interstitial keratitis. Such autoantibodies cross-react with an epitope of SSA/Ro60 protein. Anti-Ro/SSA antibodies in pregnant women cross the placenta and reach the fetal tissues inducing an immune-mediated damage of the cardiac conduction system. We wanted to evaluate whether mothers with anti-Ro/SSA antibodies who gave birth to children with congenital heart block have antibodies directed against inner ear antigens and whether these antibodies are connected with the presence of immune-mediated sensorineural hearing loss. We did not find anti-inner ear antibodies in the majority of the mothers. On the contrary a 13-year-old boy with congenital heart block and sensorineural hearing loss was positive for the presence of anti-inner ear antigens antibodies. Moreover his serum was positive for the presence of anti-Ro60 peptide antibodies but did not recognize the entire protein Ro60 (TROVE2), a behaviour similar to that of sera from patients with Cogan syndrome. In conclusion the data obtained so far show that anti-inner ear antibodies do not recognize the entire protein TROVE2 and do not support the hypothesis that such antibodies may be involved in the pathogenesis of congenital heart block.
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Affiliation(s)
- C Bason
- 1 Department of Medicine, University of Verona, Verona, Italy
| | - I Pagnini
- 2 Rheumatology Unit, Anna Meyer Children's Hospital and University of Florence, Florence, Italy
| | - A Brucato
- 3 Internal Medicine, Ospedali Riuniti di Bergamo, Bergamo, Italy
| | - S Maestroni
- 3 Internal Medicine, Ospedali Riuniti di Bergamo, Bergamo, Italy
| | - A Puccetti
- 4 Immunology Area, Ospedale Pediatrico Bambin Gesù, Rome, Italy
| | - C Lunardi
- 1 Department of Medicine, University of Verona, Verona, Italy
| | - R Cimaz
- 2 Rheumatology Unit, Anna Meyer Children's Hospital and University of Florence, Florence, Italy
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Lazzaroni MG, Dall’Ara F, Fredi M, Nalli C, Reggia R, Lojacono A, Ramazzotto F, Zatti S, Andreoli L, Tincani A. A comprehensive review of the clinical approach to pregnancy and systemic lupus erythematosus. J Autoimmun 2016; 74:106-117. [DOI: 10.1016/j.jaut.2016.06.016] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 06/27/2016] [Indexed: 01/23/2023]
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The Unique Coexistence of Anti-SS-A/Ro Antibodies in a Neonate with Symptomatic Ischemic Stroke. Pediatr Neurol 2016; 62:47-50. [PMID: 27426420 DOI: 10.1016/j.pediatrneurol.2016.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 06/08/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Neonatal cerebral infarction is a relatively common cause of neonatal seizures, with an incidence of at least 1:4000 live births and is associated with a high incidence of neurological sequelae. However, the pathophysiological mechanisms and predisposing factors responsible for neonatal infarction are not fully established. PATIENT DESCRIPTION A full-term baby boy was transferred at two days of age for the treatment of a cluster of seizures. Cranial magnetic resonance imaging revealed multiple lesions compatible with acute cerebral infarction. The results of the blood tests performed to screen for thrombophilic diseases were normal for his age, and his perinatal history was unremarkable. A diagnosis of idiopathic cerebral infarction was made. Additional examination for autoimmune diseases showed that both the mother and the patient had the anti-SS-A/Ro antibody. The patient was treated with phenobarbital and has no neurological sequelae. CONCLUSIONS This is the first report demonstrating the coexistence of neonatal cerebral infarction and neonatal lupus syndrome. Thus neonatal lupus syndrome may be an additional risk factor for neonatal stroke.
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Savino F, Viola S, Tarasco V, Locatelli E, Ricagni A, Coppo P. Neonatal lupus erythematosus: a cutaneous cases based update. Ital J Pediatr 2016; 42:1. [PMID: 26743447 PMCID: PMC4705598 DOI: 10.1186/s13052-015-0208-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 12/24/2015] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Neonatal Lupus Erythematosus (NLE) is an uncommon autoimmune disease characterized by cutaneous, hepatic, hematological, neurological and cardiac involvement. CASE PRESENTATION Here we report four cases of cutaneous NLE which were referred to our department in the last 10 years and update literature. The newborns presented with different skin, clinical and laboratory features. This underlines the phenotypic variability of NLE. We investigated the passage of maternal antinuclear antibodies (ANA) and extractable nuclear antigen antibodies (ENA) - particularly anti-Ro/SSA, anti-La/SSB and anti-U1 ribonucleoprotein RNP - through the placenta. Despite the positive family background, cutaneous NLE and serological data improved in infants within 4 months without treatment. CONCLUSION The evolution of cutaneous NLE may be the spontaneous regression of lesions within six months without progression to Systemic Lupus Erytehmatosus.
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Affiliation(s)
- Francesco Savino
- Department of Pediatrics and Adolescence - Regina Margherita Children's Hospital, Azienda Ospedaliera Città della Salute e della Scienza di Torino, University of Turin, Piazza Polonia, 94, Torino, 10126, Italy.
| | - Serena Viola
- Department of Pediatrics and Adolescence - Regina Margherita Children's Hospital, Azienda Ospedaliera Città della Salute e della Scienza di Torino, University of Turin, Piazza Polonia, 94, Torino, 10126, Italy.
| | - Valentina Tarasco
- Department of Pediatrics and Adolescence - Regina Margherita Children's Hospital, Azienda Ospedaliera Città della Salute e della Scienza di Torino, University of Turin, Piazza Polonia, 94, Torino, 10126, Italy.
| | - Emanuela Locatelli
- Department of Pediatrics and Adolescence - Regina Margherita Children's Hospital, Azienda Ospedaliera Città della Salute e della Scienza di Torino, University of Turin, Piazza Polonia, 94, Torino, 10126, Italy.
| | - Alberto Ricagni
- Department of Pediatrics and Adolescence - Regina Margherita Children's Hospital, Azienda Ospedaliera Città della Salute e della Scienza di Torino, University of Turin, Piazza Polonia, 94, Torino, 10126, Italy.
| | - Paola Coppo
- Department of Surgery, Dermatology Unit, Regina Margherita Children's Hospital, University of Turin, Turin, Italy.
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Li YQ, Wang Q, Luo Y, Zhao Y. Neonatal lupus erythematosus: a review of 123 cases in China. Int J Rheum Dis 2015; 18:761-7. [PMID: 26171790 DOI: 10.1111/1756-185x.12652] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
AIM To analyze the clinical features, outcomes and prognosis of neonatal lupus erythematosus (NLE) in China. METHOD We reviewed 12 NLE cases at the Peking Union Medical College Hospital and compared the data with 111 cases reported in China between 1990 and 2014. The Chinese medical journal search engines used in this study were Wanfang.data and Science China. RESULTS No gender dominance in NLE incidence was found. Cutaneous lesions were present in more than 96% of patients, while cardiac, hematological and hepatobiliary manifestations were seen in 12.61%, 45.53% and 17.89% of cases, respectively. Congenital heart block (CHB) tended to be more persistent, with two cases showing CHB for 1 year and three cases persisting for 7-10 years. In this study more than 90% of mothers were anti-Sjögren's syndrome A positive, and 65.04% were asymptomatic prior to the pregnancy. CONCLUSION These results indicate that clinicians, especially dermatologists, in China should improve their recognition of this disease to avoid misdiagnosis, and more attention should be paid to the follow-up of NLE patients and their asymptomatic mothers.
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Affiliation(s)
- Yi-Qun Li
- Cancer Hospital Chinese Academy of Medical Sciences, Beijing, China
| | - Qian Wang
- Department of Rheumatology, Peking Union Medical College Hospital, Beijing, China
| | - Yan Luo
- Department of Rheumatology, West China Hospital, Sichuan University, Beijing, China
| | - Yan Zhao
- Department of Rheumatology, Peking Union Medical College Hospital, Beijing, China
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Abstract
Neonatal lupus syndrome is associated with transplacental passage of maternal anti-SSA/Ro and anti-SSB/La antibodies. Children display cutaneous, hematological, liver or cardiac features. Cardiac manifestations include congenital heart block (CHB); endocardial fibroelastosis and dilated cardiomyopathy. The prevalence of CHB in newborns of anti-Ro/SSA positive women with known connective tissue disease is between 1 and 2% and the risk of recurrence is around 19%. Skin and systemic lesions are transient, whereas CHB is definitive and associated with significant morbidity and a mortality of 18%. A pacemaker must be implanted in 2/3 of cases. Myocarditis may be associated or appear secondly. Mothers of children with CHB are usually asymptomatic or display Sjogren's syndrome or undifferentiated connective tissue disease. In anti-Ro/SSA positive pregnant women, fetal echocardiography should be performed at least every 2 weeks from the 16th to 24th week gestation. An electrocardiogram should be performed for all newborn babies. The benefit of fluorinated corticosteroid therapy for CHB detected in utero remains unclear. Maternal use of hydroxychloroquine may be associated with a decreased recurrent CHB risk in a subsequent offspring. A prospective study is actually ongoing to confirm these findings.
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Döring M, Rohrer KM, Tsiflikas I, Buchenau W, Wilke M, Handgretinger R, Poets CF, Goelz R. A newborn with grouped facial skin lesions and subsequent seizures. BMC Pediatr 2014; 14:126. [PMID: 24884686 PMCID: PMC4041904 DOI: 10.1186/1471-2431-14-126] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 05/19/2014] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Congenital grouped skin lesions are alarming signs of a variety of threatening diagnoses of quite different origin. The present case report shows an impressive clinical pattern of a neonate and illustrates the difficulty in differential diagnosis of mixed connective tissue disease and neonatal lupus erythematosus in newborns. This reported case is to our knowledge the first description of an unrecognized mixed connective tissue disease in the mother with an unusual clinical manifestation in the newborn, comprising skin lesions, neurological damage and non-typical antibody constellation. CASE PRESENTATION We report on a Caucasian female neonate from a perinatally asymptomatic mother, who presented with grouped facial pustular-like skin lesions, followed by focal clonic seizures caused by multiple ischemic brain lesions. Herpes simplex virus infection was excluded and both the mother and her infant had the antibody pattern of systemic lupus erythematosus and neonatal lupus erythematosus, respectively. However, clinical signs in the mother showed overlapping features of mixed connective tissue disease. CONCLUSION This case report emphasizes congenital Lupus erythematosus and mixed connective tissue disease as important differential diagnoses of grouped skin lesions in addition to Herpes simplex virus-infection. The coexistence of different criteria for mixed connective tissue disease makes it difficult to allocate precisely maternal and congenital infantile disease.
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Affiliation(s)
- Michaela Döring
- Department I - General Paediatrics, Hematology/Oncology, University Hospital Tuebingen, Children's Hospital, Hoppe-Seyler-Str,1, Tuebingen 72076, Germany.
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