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Neonatal Lupus Erythematosus in a 2-Month-Old Girl: A Case Report

Received: 17 March 2023     Accepted: 6 April 2023     Published: 15 April 2023
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Abstract

Neonatal lupus erythematosus is a rare acquired disease involving the fetus and the newborn. It is caused by autoantibodies (mainly anti-SSA/Ro and anti-SSB/La antibodies) in the mother entering the fetus through the placenta to cause autoimmune reactions, The most common clinical manifestations of neonatal lupus erythematosus include skin involvement and congenital heart block, as well as blood, respiratory, neurological, and digestive system abnormalities. Patients often go to pediatrics or dermatology with rash as the first symptom. Because the rash is atypical, there is often a risk of misdiagnosis or missed diagnosis. We report a case of 2-month-old baby. Physical examination showed that dark red infiltrating macula was scattered on forehead and plantar. ANA positive, anti-SSA/Ro antibody positive, anti-SSB/La antibody positive, no involvement of the heart or other organ systems was found. Her mother was a patient with lupus erythematosus. The diagnosis of neonatal lupus erythematosus was made according to the history and clinical manifestations, symptomatic treatment was given to the rash site, and after 4 months, the rash disappeared at a follow-up visit. ANA, Anti SSA/Ro antibodies and anti SSB/La antibodies all turned negative. The etiology, clinical manifestation, prevention and treatment of neonatal lupus erythematosus were discussed in combination with existing literature. It was emphasized that autoantibody testing should be carried out for women and pregnant women with reproductive requirements in order to detect and prevent neonatal lupus erythematosus in time. For unexplained skin rashes of infants, if the mother has a history of connective tissue disease, the possibility of neonatal lupus erythematosus should be considered.

Published in American Journal of Pediatrics (Volume 9, Issue 2)
DOI 10.11648/j.ajp.20230902.11
Page(s) 59-62
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2023. Published by Science Publishing Group

Keywords

Erythematosus, Neonatal Lupus, Anti-SSA/Ro, Anti-SSB/La, Prognosis

References
[1] Zuppa AA, Riccardi R, Frezza S, Gallini F, Luciano RM, Alighieri G, Romagnoli C, et al. Neonatal lupus: Follow-up in infants with anti-SSA/Ro antibodies and review of the literature. Autoimmun Rev. 2017; 16 (4): 427-432.
[2] Teixeira AR, Rodrigues M, Guimarães H, Moura C, Brito I. Neonatal lupus - case series of a tertiary hospital. Acta Reumatol Port. 2017; 42 (4): 318-323.
[3] 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 (14): 3195.
[4] Dalal DS, Patel KA, Patel MA. Systemic Lupus Erythematosus and Pregnancy: A Brief Review. J Obstet Gynaecol India. 2019; 69 (2): 104-109.
[5] Yu Y, Du L, Pan J, Zheng J, Chen A, Chen L. A 10-year retrospective study of neonatal lupus erythematous in China. Asian Pac J Allergy Immunol. 2016; 34 (2): 174-178.
[6] Pereira S, Flor-de-Lima F, Soares H, Vilan A, Ferraz C, Rodrigues M, Moura C, et al. Pulmonary involvement in neonatal lupus: a challenging diagnosis - case report and literature review. Acta Reumatol Port. 2018; 43 (3): 230-234.
[7] Li YQ, Wang Q, Luo Y, Zhao Y. Neonatal lupus erythematosus: a review of 123 cases in China. Int J Rheum Dis. 2015; 18 (7): 761-767.
[8] Singalavanija S, Limpongsanurak W, Aoongern S. Neonatal lupus erythematosus: a 20-year retrospective study. J Med Assoc Thai. 2014; 97 Suppl 6: S74-82.
[9] Clowse MEB, Eudy AM, Kiernan E, Williams MR, Bermas B, Chakravarty E, Sammaritano LR, et al. The prevention, screening and treatment of congenital heart block from neonatal lupus: a survey of provider practices. Rheumatology (Oxford). 2018; 57 (suppl5): v9-v17.
[10] Li X, Huang X, Lu H. Two case reports of neonatal autoantibody-associated congenital heart block. Medicine (Baltimore), 2018; 97 (45): e13185.
[11] Lee LA. Neonatal lupus erythematosus: clinical findings and pathogenesis. J Investig Dermatol Symp Proc. 2004; 9 (1): 52-56.
[12] Assari R, Ziaee V, Moradinejad MH, Mirmohammadsadeghi A. Neonatal Lupus erythematosus Following Rheumatoid Arthritis: Case Report and Literature Review. Iran J Pediatr. 2014; 24 (4): 445-448.
[13] Zuppa AA, Fracchiolla A, Cota F, Gallini F, Savarese I, D'Andrea V, Luciano R, et al. Infants born to mothers with anti-SSA/Ro autoantibodies: neonatal outcome and follow-up. Clin Pediatr (Phila). 2008; 47 (3): 231-236.
[14] Gryka-Marton M, Szukiewicz D, Teliga-Czajkowska J, Olesinska M. An Overview of Neonatal Lupus with Anti-Ro Characteristics. Int J Mol Sci. 2021; 22 (17): 9281.
[15] Barsalou J, Costedoat-Chalumeau N, Berhanu A, Fors-Nieves C, Shah U, Brown P, Laskin CA, et al. Effect of in utero hydroxychloroquine exposure on the development of cutaneous neonatal lupus erythematosus. Ann Rheum Dis. 2018; 77 (12): 1742-1749.
[16] Barsalou J, Jaeggi E, Laskin CA, Brown P, Tian SY, Hamilton RM, Silverman ED. Prenatal exposure to antimalarials decreases the risk of cardiac but not non-cardiac neonatal lupus: a single-centre cohort study. Rheumatology (Oxford). 2017; 56 (9): 1552-1559.
[17] Dao KH, Bermas BL. Systemic Lupus Erythematosus Management in Pregnancy. Int J Womens Health. 2022; 14: 199-211.
Cite This Article
  • APA Style

    Runchao Wang, Haixia Jing, Tingting Chen, Rui Wu, Wentao Liu. (2023). Neonatal Lupus Erythematosus in a 2-Month-Old Girl: A Case Report. American Journal of Pediatrics, 9(2), 59-62. https://doi.org/10.11648/j.ajp.20230902.11

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    ACS Style

    Runchao Wang; Haixia Jing; Tingting Chen; Rui Wu; Wentao Liu. Neonatal Lupus Erythematosus in a 2-Month-Old Girl: A Case Report. Am. J. Pediatr. 2023, 9(2), 59-62. doi: 10.11648/j.ajp.20230902.11

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    AMA Style

    Runchao Wang, Haixia Jing, Tingting Chen, Rui Wu, Wentao Liu. Neonatal Lupus Erythematosus in a 2-Month-Old Girl: A Case Report. Am J Pediatr. 2023;9(2):59-62. doi: 10.11648/j.ajp.20230902.11

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  • @article{10.11648/j.ajp.20230902.11,
      author = {Runchao Wang and Haixia Jing and Tingting Chen and Rui Wu and Wentao Liu},
      title = {Neonatal Lupus Erythematosus in a 2-Month-Old Girl: A Case Report},
      journal = {American Journal of Pediatrics},
      volume = {9},
      number = {2},
      pages = {59-62},
      doi = {10.11648/j.ajp.20230902.11},
      url = {https://doi.org/10.11648/j.ajp.20230902.11},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajp.20230902.11},
      abstract = {Neonatal lupus erythematosus is a rare acquired disease involving the fetus and the newborn. It is caused by autoantibodies (mainly anti-SSA/Ro and anti-SSB/La antibodies) in the mother entering the fetus through the placenta to cause autoimmune reactions, The most common clinical manifestations of neonatal lupus erythematosus include skin involvement and congenital heart block, as well as blood, respiratory, neurological, and digestive system abnormalities. Patients often go to pediatrics or dermatology with rash as the first symptom. Because the rash is atypical, there is often a risk of misdiagnosis or missed diagnosis. We report a case of 2-month-old baby. Physical examination showed that dark red infiltrating macula was scattered on forehead and plantar. ANA positive, anti-SSA/Ro antibody positive, anti-SSB/La antibody positive, no involvement of the heart or other organ systems was found. Her mother was a patient with lupus erythematosus. The diagnosis of neonatal lupus erythematosus was made according to the history and clinical manifestations, symptomatic treatment was given to the rash site, and after 4 months, the rash disappeared at a follow-up visit. ANA, Anti SSA/Ro antibodies and anti SSB/La antibodies all turned negative. The etiology, clinical manifestation, prevention and treatment of neonatal lupus erythematosus were discussed in combination with existing literature. It was emphasized that autoantibody testing should be carried out for women and pregnant women with reproductive requirements in order to detect and prevent neonatal lupus erythematosus in time. For unexplained skin rashes of infants, if the mother has a history of connective tissue disease, the possibility of neonatal lupus erythematosus should be considered.},
     year = {2023}
    }
    

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  • TY  - JOUR
    T1  - Neonatal Lupus Erythematosus in a 2-Month-Old Girl: A Case Report
    AU  - Runchao Wang
    AU  - Haixia Jing
    AU  - Tingting Chen
    AU  - Rui Wu
    AU  - Wentao Liu
    Y1  - 2023/04/15
    PY  - 2023
    N1  - https://doi.org/10.11648/j.ajp.20230902.11
    DO  - 10.11648/j.ajp.20230902.11
    T2  - American Journal of Pediatrics
    JF  - American Journal of Pediatrics
    JO  - American Journal of Pediatrics
    SP  - 59
    EP  - 62
    PB  - Science Publishing Group
    SN  - 2472-0909
    UR  - https://doi.org/10.11648/j.ajp.20230902.11
    AB  - Neonatal lupus erythematosus is a rare acquired disease involving the fetus and the newborn. It is caused by autoantibodies (mainly anti-SSA/Ro and anti-SSB/La antibodies) in the mother entering the fetus through the placenta to cause autoimmune reactions, The most common clinical manifestations of neonatal lupus erythematosus include skin involvement and congenital heart block, as well as blood, respiratory, neurological, and digestive system abnormalities. Patients often go to pediatrics or dermatology with rash as the first symptom. Because the rash is atypical, there is often a risk of misdiagnosis or missed diagnosis. We report a case of 2-month-old baby. Physical examination showed that dark red infiltrating macula was scattered on forehead and plantar. ANA positive, anti-SSA/Ro antibody positive, anti-SSB/La antibody positive, no involvement of the heart or other organ systems was found. Her mother was a patient with lupus erythematosus. The diagnosis of neonatal lupus erythematosus was made according to the history and clinical manifestations, symptomatic treatment was given to the rash site, and after 4 months, the rash disappeared at a follow-up visit. ANA, Anti SSA/Ro antibodies and anti SSB/La antibodies all turned negative. The etiology, clinical manifestation, prevention and treatment of neonatal lupus erythematosus were discussed in combination with existing literature. It was emphasized that autoantibody testing should be carried out for women and pregnant women with reproductive requirements in order to detect and prevent neonatal lupus erythematosus in time. For unexplained skin rashes of infants, if the mother has a history of connective tissue disease, the possibility of neonatal lupus erythematosus should be considered.
    VL  - 9
    IS  - 2
    ER  - 

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Author Information
  • Department of Dematology, Taihe Hospital, Hubei University of Medicine, Shiyan, China

  • Department of Dematology, Taihe Hospital, Hubei University of Medicine, Shiyan, China

  • Department of Dematology, Taihe Hospital, Hubei University of Medicine, Shiyan, China

  • Department of Dematology, Taihe Hospital, Hubei University of Medicine, Shiyan, China

  • Department of Dematology, Taihe Hospital, Hubei University of Medicine, Shiyan, China

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