Pediatric emergency medicine trisk 1333 1333
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PATCHES AND PLAQUES
Annular Rash
Neonatal Lupus
Neonatal lupus is an autoimmune disorder caused by the passive transfer of
maternal autoantibodies, anti-Ro, anti-La, and, less commonly, antiribonucleoprotein (U1-RNP) ( Fig. 69.9 ). The skin and heart are commonly
affected, with the most serious complication being third-degree atrioventricular
heart block, which results in fetal and neonatal mortality rates of 15% to 30%.
Ten percent of patients experience thrombocytopenia, neutropenia, or anemia,
which are usually transient. Neonatal lupus can present as annular (ring-like), red,
scaly patches, most commonly on the head and neck. Rash around the periorbital
region should make suspicion very high ( Fig. 69.10 ). Neonatal lupus can also
manifest as scaly atrophic patches similar to discoid lupus. Mucosal erosions have
been noted in some infants. The diagnosis also has implications for the mother
and her future pregnancies. Women who have had a child with NLE have an
increased risk of having a child with neonatal lupus in subsequent pregnancies.
Up to 83% of mothers who have an infant diagnosed with NLE are themselves
asymptomatic at the time. However, approximately 50% of these mothers have or
will subsequently develop an autoimmune disorder, commonly Sjogren disease.
Any annular erythematous rash in a newborn should be assumed to be NLE until
definitively proven otherwise.
