P011 A case report of neonatal lupus erythematosus in a 3-month-old baby (2024)

Neonatal lupus erythematosus (LE) is an uncommon clinical condition caused by the transfer of anti-Ro/SSA or anti-La/SSB transplacentally from the mother to the fetus (Costa Cascais F, Fraga S, Sousa S, Pinto M. Neonatal lupus: a clinical challenge. BMJ Case Rep 2021; 14: e246590). The incidence of neonatal LE is about 1 in 20000 live births, with female neonates twice as likely to be affected compared than male (Sukumaran S, Singh D. Cutaneous neonatal lupus erythematosus: a case report. Cureus 2022; 14: e22279). We report a case of neonatal LE in a 3-month-old male infant who presented with multiple annular erythematous lesions on his scalp and feet. A 3-month-old baby was referred by the general practitioner after multiple annular erythematous lesions were noted on his scalp and feet. He was delivered at term via a spontaneous vertex vagin*l birth. The APGAR (appearance, pulse, grimace, activity and respiration) score was 9 at 1 min and 10 at 5 min. The birthweight was 3440 g. The mother had routine prenatal care for an uncomplicated pregnancy. The rashes were first observed at 4 weeks after delivery and were treated with co-trimoxazole cream; however, there was no response, which prompted a referral to the dermatology department. The infant was seen physically 3 weeks after the initial virtual review. There were erythematous annular rashes with slightly rolled edges on the scalp and soles of the feet. The remainder of the examination was normal. He was started on hydrocortisone–miconazole cream and reviewed again 6 weeks later, when the rash had faded considerably on the temporal sides of his scalp and resolved completely on his left foot. A differential diagnosis of fungal infection/granuloma annulare/resolving viral infection was considered. However, as the rash did not completely resolve after a further review 3 weeks later, the differential of neonatal LE was considered and screening for neonatal lupus was performed, which came back positive. Antinuclear antibody was positive (titre 360, speckled pattern), and anti-Ro/SSA antibodies were positive. He was prescribed clobetasone cream as treatment. Maternal serology was later checked, revealing anti-Ro/SSA, anti-La/SSB and high-titre antinuclear antibodies. However, the mother was completely asymptomatic. Preliminary cardiac and blood investigations by the paediatrician did not reveal any abnormality. Cutaneous involvement is usually self-limiting, though topical steroids may be needed in some cases. Cardiac involvement should be actively screened for, as pacemakers may be needed for atrioventricular block.