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Facial Rash, Fever, and Anemia in a Newborn

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.
1 Credit CME

A 19-day-old Japanese male infant presented with a 12-day history of fevers and facial rash. He was born by spontaneous vaginal delivery at 36 weeks’ gestational age with a birthweight of 3048 g (6.7 lb) with Apgar scores of 9 and 10. There were no complications during the prenatal and perinatal periods. His mother had no history of ringworm infection, positive IgG antibodies against rubella virus and herpes zoster virus, and serology findings negative for human immunodeficiency virus, hepatitis B virus, and syphilis. His family history was unremarkable.

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Neonatal lupus

C. Order antinuclear antibody, anti-Ro/SS-A, and anti-La/SS-B antibody testing for both the infant and his mother

The key to the correct diagnosis is the presence of characteristic erythematous plaques on the face, including the periorbital areas, along with anemia and low-grade fever. The diagnosis of neonatal lupus can be made if a neonate born to a mother with anti-Ro/SS-A or anti-La/SS-B antibodies develops facial annular plaques. Congenital syphilis (choice D) may be considered, but mucosal, periorificial, and palmar and plantar lesions are common in congenital syphilis and not seen in this case. It is important to avoid misdiagnosis, as false-positive syphilis antibody tests can occur in systemic lupus erythematosus. Infantile seborrheic dermatitis (choice A) does not present with annular infiltrated plaques. Tinea faciei (choice B) is unlikely in a newborn without a history of ringworm in the mother.

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Article Information

Corresponding Author: Mitsuhito Ota, MD, PhD, Department of Dermatology, Chitose City Hospital, Hokkou 2, Chitose 066-8550, Japan (ota@med.hokudai.ac.jp).

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

Additional Contributions: We thank the patient’s mother for permission to share the patient’s information.

References
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Izmirly  PM, Saxena  A, Kim  MY,  et al.  Maternal and fetal factors associated with mortality and morbidity in a multi-racial/ethnic registry of anti-SSA/Ro-associated cardiac neonatal lupus.  Circulation. 2011;124(18):1927-1935.PubMedGoogle ScholarCrossref
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Brito-Zerón  P, Izmirly  PM, Ramos-Casals  M, Buyon  JP, Khamashta  MA.  The clinical spectrum of autoimmune congenital heart block.  Nat Rev Rheumatol. 2015;11(5):301-312.PubMedGoogle ScholarCrossref
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Clowse  MEB, Eudy  AM, Bermas  BL, Chakravarty  E, Sammaritano  LR, Chambers  CD.  The prevention, screening, and treatment of congenital heart block from neonatal lupus: a survey of provider practices.  Arthritis Rheumatol. 2016;(68)(suppl 10):3236-3237.Google Scholar
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