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Agnihotri G, Tsoukas MM. Annular skin lesions in infancy. Clin Dermatol 2023; 41:405-412. [PMID: 37467898 DOI: 10.1016/j.clindermatol.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
Annular skin lesions have a unique morphology, and the dramatic appearance of these skin eruptions in infants can cause concern for parents and clinicians. Annular lesions appearing during infancy (defined here as birth to 1 year of age) lend to a broad differential, ranging from benign cutaneous disorders to severe systemic diseases. This review summarizes the pathogenesis, clinical and histopathologic findings, and management options of possible etiologies for annular skin lesions in infants, including annular erythema of infancy, neonatal lupus erythematosus, dermatophyte infections, hemorrhagic edema of infancy, and urticaria multiforme.
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Affiliation(s)
- Gaurav Agnihotri
- Department of Dermatology, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Maria M Tsoukas
- Department of Dermatology, University of Illinois at Chicago, Chicago, Illinois, USA.
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2
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Paolino G, Rongioletti F. Annular dermatoses with rheumatologic implications. Clin Dermatol 2023; 41:376-381. [PMID: 37437750 DOI: 10.1016/j.clindermatol.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
A wide variety of cutaneous disorders present with annular (ringlike) skin lesions, and some of them carry rheumatologic implications because they may involve the joints or belong to the spectrum of connective tissue diseases. The diagnosis of an annular rheumatologic skin disease is possible with a correct clinicopathologic correlation, with a correct anamnesis of the patient, with the evaluation of systemic symptoms, laboratory and instrumental investigations, and finally with a cutaneous biopsy.
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Affiliation(s)
- Giovanni Paolino
- IRCCS Ospedale San Raffaele, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy.
| | - Franco Rongioletti
- IRCCS Ospedale San Raffaele, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy
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3
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Abstract
Annular skin lesions have a unique morphology, and the dramatic appearance of these skin eruptions in infants can cause concern for parents and clinicians. Annular lesions appearing during infancy (defined here as birth to 1 year of age) lend to a broad differential, ranging from benign cutaneous disorders to severe systemic diseases. This review summarizes the pathogenesis, clinical and histopathologic findings, and management options of possible etiologies for annular skin lesions in infants, including annular erythema of infancy, neonatal lupus erythematosus, dermatophyte infections, hemorrhagic edema of infancy, and urticaria multiforme.
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Affiliation(s)
- Gaurav Agnihotri
- University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Maria M Tsoukas
- Department of Dermatology, University of Illinois at Chicago, College of Medicine, Chicago, Illinois, USA.
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4
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Raman J, Wells A, Chung M, Saikaly SK, Bender N. Cutaneous eruption in neonate with congenital heart defect. JAAD Case Rep 2022; 28:116-118. [PMID: 36159724 PMCID: PMC9489870 DOI: 10.1016/j.jdcr.2022.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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5
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Zdraveska N, Kostovski A, Sofijanova A, Jancevska S, Jovanovska J, Kacarska M, Damevska K. Neonatal lupus erythematosus—a rare syndrome of transient autoimmunity. Clin Case Rep 2022; 10:e6004. [PMID: 35782217 PMCID: PMC9233163 DOI: 10.1002/ccr3.6004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/04/2022] [Accepted: 06/08/2022] [Indexed: 11/11/2022] Open
Abstract
Neonatal lupus erythematosus (NLE) is a rare autoimmune disease due to a passive transfer of maternal autoantibodies to the fetus. The clinical spectrum is variable and includes skin lesions, cardiac, hematological, or hepatobiliary disorders. We report an NLE case presenting with skin eruption that was initially considered as tinea. Neonatal lupus erythematosus is a rare neonatal disease due to maternal autoimmunity which can have various clinical presentations. Although cutaneous NLE is a transient condition, it should be recognized promptly due to the risk of recurrence in the subsequent pregnancies.
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Affiliation(s)
- Nikolina Zdraveska
- University Children Hospital, Faculty of Medicine Ss Cyril and Methodius University in Skopje North Macedonia
| | - Aco Kostovski
- University Children Hospital, Faculty of Medicine Ss Cyril and Methodius University in Skopje North Macedonia
| | - Aspazija Sofijanova
- University Children Hospital, Faculty of Medicine Ss Cyril and Methodius University in Skopje North Macedonia
| | - Snezana Jancevska
- University Clinic for Obstetrics and Gynecology, Faculty of Medicine Ss Cyril and Methodius University in Skopje North Macedonia
| | - Jana Jovanovska
- University Children Hospital, Faculty of Medicine Ss Cyril and Methodius University in Skopje North Macedonia
| | - Milena Kacarska
- University Children Hospital, Faculty of Medicine Ss Cyril and Methodius University in Skopje North Macedonia
| | - Katerina Damevska
- University Clinic of Dermatology, Faculty of Medicine Ss Cyril and Methodius University in Skopje North Macedonia
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6
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Bitar C, Menge TD, Chan MP. Cutaneous manifestations of lupus erythematosus: A practical clinicopathologic review for pathologists. Histopathology 2021; 80:233-250. [PMID: 34197657 DOI: 10.1111/his.14440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 06/30/2021] [Indexed: 11/27/2022]
Abstract
Accurate diagnosis of connective tissue diseases is often challenging and relies on careful correlation between clinical and histopathologic features, direct immunofluorescence studies, and laboratory workup. Lupus erythematosus (LE) is a prototype of connective tissue disease with a variety of cutaneous and systemic manifestations. Microscopically, cutaneous LE is classically characterized by an interface dermatitis, although other histopathologic patterns also exist depending on the clinical presentation, location, and chronicity of the skin lesions. In this article, we review the clinical, serologic, histopathologic, and direct immunofluorescence findings in LE-specific and LE-nonspecific skin lesions, with an emphasis on lesser known variants, newly described features, and helpful ancillary studies. This review will guide general pathologists and dermatopathologists in accurately diagnosing and subclassifying cutaneous LE.
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Affiliation(s)
- Carole Bitar
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.,Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Tyler D Menge
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.,Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - May P Chan
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.,Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
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7
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Bernard H, Rea C. Neonatal lupus presenting as a non-specific rash in primary care. BMJ Case Rep 2020; 13:13/12/e237463. [PMID: 33318248 PMCID: PMC7737015 DOI: 10.1136/bcr-2020-237463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Neonatal lupus erythematosus is a rare autoimmune disease caused by passive transplacental acquisition of maternal autoantibodies manifesting in cutaneous, cardiac, haematological and hepatobiliary abnormalities. The hallmark dermatological finding is erythematous annular lesions with a predilection for photo-exposed areas of the skin. We present a case of a female infant born to a mother with Sjogren's syndrome, who initially presented to an ambulatory care setting with non-specific erythematous papules involving the face and scalp. Within 6 days the rash changed in appearance, consisting of widespread erythematous annular and polycyclic lesions with central violaceous clearing and atrophy. Serological tests revealed asymptomatic anemia and leukopenia, elevated liver enzymes, and positive antinuclear antibodies (ANA) and anti-SSb/La antibodies. Further cardiac evaluation was normal. She was managed conservatively in the outpatient setting with topical steroids, avoidance of sunlight and fluorescent light exposure, and primary care, rheumatological and dermatological follow-up.
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Affiliation(s)
- Heather Bernard
- Harvard Medical School, Boston, Massachusetts, USA,Boston Children's Hospital Division of General Pediatrics, Boston, Massachusetts, USA
| | - Corinna Rea
- Harvard Medical School, Boston, Massachusetts, USA,Boston Children's Hospital Division of General Pediatrics, Boston, Massachusetts, USA
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8
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Abstract
BACKGROUND Neonatal lupus erythematosus (NLE) results from cross-placental transfer of maternal autoantibodies. Neonates can present with cardiac, cutaneous, hepatobiliary, hematologic, and neurologic complications from antibody-mediated organ toxicity. Scant evidence exists on long-term clinical characteristics and outcomes of patients with neonatal lupus. OBJECTIVES To characterize the autoantibody profile, laboratory, and clinical features of patients with NLE. MATERIALS/METHODS This was a single-site retrospective cohort study of patients at the Children's Hospital of Philadelphia with NLE. Data were collected on clinical, laboratory, and autoantibody profile at time of presentation, as well as long-term complications. RESULTS Thirteen patients were included. Congenital cardiac findings were reported in 3 patients, with 1 having persistent cardiac sequelae. Cardiac manifestations were correlated with anti-Ro/SSA positivity in our cohort. Two patients had neurologic findings, with good long-term outcomes. Cutaneous findings were present in all patients, and many resolved without topical steroid treatment. Hematologic and hepatobiliary findings were common, but uncomplicated, with complete resolution by 6 months after initial presentation in all. Maternal rheumatologic disease, treatment, and race were not associated with systemic manifestations. CONCLUSIONS Patients born to mothers with positive anti-Ro/SSA titers may benefit from routine cardiac monitoring in utero and at birth. Routine EEG or head ultrasound monitoring in patients who are autoantibody positive for NLE may be unnecessary. Information regarding long-term outcomes in NLE can be used to guide familial counseling and the use of serial laboratory testing.
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Affiliation(s)
- Yixin Ally Wang
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cathryn Sibbald
- Section of Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Amanda T Moon
- Section of Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Radin M, Schreiber K, Cuadrado MJ, Cecchi I, Andreoli L, Franceschini F, Caleiro T, Andrade D, Gibbone E, Khamashta M, Buyon J, Izmirly P, Aguirre MA, Benedetto C, Roccatello D, Marozio L, Sciascia S. Pregnancy outcomes in mixed connective tissue disease: a multicentre study. Rheumatology (Oxford) 2019; 58:2000-2008. [DOI: 10.1093/rheumatology/kez141] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/17/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
In this study we aimed to investigate foetal and maternal pregnancy outcomes from a large multicentre cohort of women diagnosed with MCTD and anti-U1RNP antibodies.
Methods
This multicentre retrospective cohort study describes the outcomes of 203 pregnancies in 94 consecutive women ever pregnant who fulfilled the established criteria for MCTD with confirmed U1RNP positivity.
Results
The foetal outcomes in 203 pregnancies were as follows: 146 (71.9%) live births, 38 (18.7%) miscarriages (first trimester pregnancy loss of <12 weeks gestation), 18 (8.9%) stillbirths (pregnancy loss after 20 weeks gestation) and 11 (5.4%) cases with intrauterine growth restriction. Maternal pregnancy outcomes were as follows: 8 (3.9%) developed pre-eclampsia, 2 (0.9%) developed eclampsia, 31 (15.3%) developed gestational hypertension and 3 (1.5%) developed gestational diabetes. Women with MCTD and aPL and pulmonary or muscular involvement had worse foetal outcomes compared with those without. Moreover, we report a case of complete congenital heart block (0.45%) and a case of cutaneous neonatal lupus, both born to a mother with positive isolated anti-U1RNP and negative anti-Ro/SSA antibodies.
Conclusion
In our multicentre cohort, women with MCTD had a live birth rate of 72%. While the true frequency of heart block associated with anti-U1RNP remains to be determined, this study might raise the consideration of echocardiographic surveillance in this setting. Pregnancy counselling should be considered in women with MCTD.
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Affiliation(s)
- Massimo Radin
- Center of Research of Immunopathology and Rare Diseases, Coordinating Center of Piemonte and Valle d’Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences and SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital and University of Turin, Turin, Italy
| | - Karen Schreiber
- Center of Research of Immunopathology and Rare Diseases, Coordinating Center of Piemonte and Valle d’Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences and SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital and University of Turin, Turin, Italy
- Center of Research of Immunopathology and Rare Diseases, Coordinating Center of Piemonte and Valle d’Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences and SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital and University of Turin, Turin, Italy
| | - Maria José Cuadrado
- Center of Research of Immunopathology and Rare Diseases, Coordinating Center of Piemonte and Valle d’Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences and SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital and University of Turin, Turin, Italy
| | - Irene Cecchi
- Center of Research of Immunopathology and Rare Diseases, Coordinating Center of Piemonte and Valle d’Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences and SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital and University of Turin, Turin, Italy
| | - Laura Andreoli
- Center of Research of Immunopathology and Rare Diseases, Coordinating Center of Piemonte and Valle d’Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences and SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital and University of Turin, Turin, Italy
| | - Franco Franceschini
- Center of Research of Immunopathology and Rare Diseases, Coordinating Center of Piemonte and Valle d’Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences and SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital and University of Turin, Turin, Italy
| | - Teresa Caleiro
- Center of Research of Immunopathology and Rare Diseases, Coordinating Center of Piemonte and Valle d’Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences and SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital and University of Turin, Turin, Italy
| | - Danieli Andrade
- Center of Research of Immunopathology and Rare Diseases, Coordinating Center of Piemonte and Valle d’Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences and SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital and University of Turin, Turin, Italy
| | - Elena Gibbone
- Center of Research of Immunopathology and Rare Diseases, Coordinating Center of Piemonte and Valle d’Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences and SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital and University of Turin, Turin, Italy
| | - Munther Khamashta
- Center of Research of Immunopathology and Rare Diseases, Coordinating Center of Piemonte and Valle d’Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences and SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital and University of Turin, Turin, Italy
| | - Jill Buyon
- Center of Research of Immunopathology and Rare Diseases, Coordinating Center of Piemonte and Valle d’Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences and SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital and University of Turin, Turin, Italy
| | - Peter Izmirly
- Center of Research of Immunopathology and Rare Diseases, Coordinating Center of Piemonte and Valle d’Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences and SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital and University of Turin, Turin, Italy
| | - Maria Angeles Aguirre
- Center of Research of Immunopathology and Rare Diseases, Coordinating Center of Piemonte and Valle d’Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences and SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital and University of Turin, Turin, Italy
| | - Chiara Benedetto
- Center of Research of Immunopathology and Rare Diseases, Coordinating Center of Piemonte and Valle d’Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences and SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital and University of Turin, Turin, Italy
| | - Dario Roccatello
- Center of Research of Immunopathology and Rare Diseases, Coordinating Center of Piemonte and Valle d’Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences and SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital and University of Turin, Turin, Italy
| | - Luca Marozio
- Center of Research of Immunopathology and Rare Diseases, Coordinating Center of Piemonte and Valle d’Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences and SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital and University of Turin, Turin, Italy
| | - Savino Sciascia
- Center of Research of Immunopathology and Rare Diseases, Coordinating Center of Piemonte and Valle d’Aosta Network for Rare Diseases, Department of Clinical and Biological Sciences and SCDU Nephrology and Dialysis, S. Giovanni Bosco Hospital and University of Turin, Turin, Italy
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Barsalou J, Costedoat-Chalumeau N, Berhanu A, Fors-Nieves C, Shah U, Brown P, Laskin CA, Morel N, Levesque K, Buyon JP, Silverman ED, Izmirly PM. Effect of in utero hydroxychloroquine exposure on the development of cutaneous neonatal lupus erythematosus. Ann Rheum Dis 2018; 77:1742-1749. [PMID: 30297329 DOI: 10.1136/annrheumdis-2018-213718] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 08/07/2018] [Accepted: 08/07/2018] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Cutaneous neonatal lupus (cNL) occurs in possibly 5%-16% of anti-Ro±anti-La antibody-exposed infants. Data suggest in utero exposure to hydroxychloroquine (HCQ) may prevent cardiac NL. The aim was to assess whether in utero exposure to HCQ decreases the risk of cNL and/or delays onset. METHODS A multicentre case-control study was performed with 122 cNL cases and 434 controls born to women with a rheumatological disease who had documentation of maternal anti-Ro±anti-La antibodies at pregnancy and confirmation of medication use and the child's outcome. A secondary analysis was performed on 262 cNL cases, irrespective of maternal diagnosis, to determine if HCQ delayed time to cNL onset. RESULTS Twenty (16%) cNL cases were exposed to HCQ compared with 146 (34%) controls (OR 0.4 (95% CI 0.2 to 0.6); p<0.01). Exposure to HCQ was associated with a reduced risk of cNL; exposure to anti-La antibody and female gender were associated with an increased risk of cNL. Exposure to HCQ remained significantly associated with a reduced cNL risk in the analyses limited to mothers with systemic lupus erythematosus and those who developed rash ≤1 month. When analysing all 262 cNL cases, HCQ-exposed infants were older (6.0 (95% CI 5.7 to 6.3) weeks) at cNL onset versus HCQ-non-exposed infants (4.4 (95% CI 3.9 to 5.0) weeks), but the difference was not statistically significant (p=0.21). CONCLUSION Exposure to HCQ was associated with a reduced risk of cNL. Among cNL cases, those exposed to HCQ tend to have later onset of rash. Both findings suggest a protective effect of HCQ on cNL.
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Affiliation(s)
- Julie Barsalou
- Division of Rheumatology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nathalie Costedoat-Chalumeau
- Department of Internal Medicine, Cochin Hospital, Centre de Référence Maladies Auto-Immunes et Systémiques Rares, AP-HP, Université Paris Descartes-Sorbonne Paris Cité, Paris, France
| | - Adey Berhanu
- Arthritis & Rheumatism Associates, PS Wheaton, Maryland, USA
| | - Cesar Fors-Nieves
- Division of Rheumatology, New York University School of Medicine, New York City, New York, USA
| | - Ummara Shah
- Division of Allergy, Immunology and Rheumatology, University of Rochester, School of Medicine and Dentistry, Rochester, USA
| | - Patrick Brown
- Department of Statistical Science, University of Toronto, Centre for Global Health Research, St Michael's Hospital, Toronto, Ontario, Canada
| | - Carl A Laskin
- Department of Medicine, Obstetrics and Gynaecology, University of Toronto, TRIO Fertility, Toronto, Ontario, Canada
| | - Nathalie Morel
- Department of Internal Medicine, Cochin Hospital, Centre de Référence Maladies Auto-Immunes et Systémiques Rares, AP-HP, Université Paris Descartes-Sorbonne Paris Cité, Paris, France
| | - Kateri Levesque
- Department of Internal Medicine, Cochin Hospital, Centre de Référence Maladies Auto-Immunes et Systémiques Rares, AP-HP, Université Paris Descartes-Sorbonne Paris Cité, Paris, France
| | - Jill P Buyon
- Division of Rheumatology, New York University School of Medicine, New York City, New York, USA
| | - Earl D Silverman
- Division of Rheumatology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Peter M Izmirly
- Division of Rheumatology, New York University School of Medicine, New York City, New York, USA
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11
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Liu RF, Chung WH, Yang CY, Wang FY, Chen CB. Neonatal lupus erythematosus presenting as Stevens-Johnson syndrome. DERMATOL SIN 2018. [DOI: 10.1016/j.dsi.2017.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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12
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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; 56:1552-1559. [DOI: 10.1093/rheumatology/kex191] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Indexed: 11/14/2022] Open
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13
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Sontichai W, Pruksachatkun C, Mahanupab P. A Facial Rash in an Infant. Pediatr Dermatol 2016; 33:219-20. [PMID: 27001320 DOI: 10.1111/pde.12760] [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: 11/29/2022]
Affiliation(s)
- Watchareewan Sontichai
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Chulabhorn Pruksachatkun
- Division of Dermatology, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pongsak Mahanupab
- Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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14
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Sitthinamsuwan P, Nitiyarom R, Chairatchaneeboon M, Wisuthsarewong W. Histiocytoid neutrophilic dermatitis, an unusual histopathology in neonatal lupus erythematosus. J Cutan Pathol 2015; 42:996-999. [DOI: 10.1111/cup.12594] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 11/21/2014] [Accepted: 11/26/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Panitta Sitthinamsuwan
- Department of Pathology; Faculty of Medicine, Siriraj Hospital, Mahidol University; Bangkok Thailand
| | - Rattanavalai Nitiyarom
- Department of Pediatrics; Faculty of Medicine, Siriraj Hospital, Mahidol University; Bangkok Thailand
| | | | - Wanee Wisuthsarewong
- Department of Pediatrics; Faculty of Medicine, Siriraj Hospital, Mahidol University; Bangkok Thailand
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15
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Nahidi Y, Meibodi NT, Javidi Z, Moghimi HR. Annular Erythematous Plaques on the Face, Trunk and Extremities of an Infant. Indian J Dermatol 2015; 60:316-8. [PMID: 26120172 PMCID: PMC4458957 DOI: 10.4103/0019-5154.156411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Yalda Nahidi
- Department of Dermatology, Research Center for Skin Diseases and Cutaneous Leishmanaisis, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Naser Tayyebi Meibodi
- Department of Pathology, Research Center for Skin Diseases and Cutaneous Leishmanaisis, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zari Javidi
- Department of Dermatology, Research Center for Skin Diseases and Cutaneous Leishmanaisis, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamid Reza Moghimi
- Department of Pathology, Research Center for Skin Diseases and Cutaneous Leishmanaisis, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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16
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Johnson B. Overview of neonatal lupus. J Pediatr Health Care 2014; 28:331-41. [PMID: 24100008 DOI: 10.1016/j.pedhc.2013.07.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 07/02/2013] [Accepted: 07/17/2013] [Indexed: 11/26/2022]
Abstract
Neonatal lupus (NL) is defined by the presentation of the fetus and the newborn who possess autoantibodies received from the mother. It is the dysfunction of the maternal immune system that leads to the production of autoantibodies to anti-Sjögren syndrome-A, anti-Sjögren syndrome-B, and anti-ribonuclear protein antigens. These antibodies are shared through the placenta and produce bodily changes in the fetal skin and heart, as well as potential changes in other body systems. Congenital complete heart block is the most dangerous manifestation of NL that can occur in utero or after birth. This article will provide an overview the presentation of NL and current therapies. Prenatal steroids have been the mainstay of therapy to try to reverse first- and second-degree congenital heart block and to prevent progression to a more advanced stage. New therapies are combining steroids with intravenous immunoglobulin and plasmapheresis. This article will provide guidelines for practitioners so they can consider NL as a differential diagnosis when presented with cutaneous lesions, congenital heart block, or abnormal findings in the hematologic, hepatobiliary, neurologic, and musculoskeletal systems.
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17
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Trevisan F, Cunha PR, Pinto CAL, Cattete FG. Cutaneous neonatal lupus with cutis marmorata telangiectatica congenita-like lesions. An Bras Dermatol 2014; 88:428-31. [PMID: 23793203 PMCID: PMC3754378 DOI: 10.1590/abd1806-4841.20131832] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 06/04/2012] [Indexed: 11/21/2022] Open
Abstract
Neonatal lupus is a rare disease caused by the transplacental transfer of maternal
autoantibodies to the foetus, characterized by transient clinical manifestations such
as cutaneous, haematological, and hepatobiliary events or permanent such as
congenital heart block. The typical cutaneous manifestations include erythematous,
scaly, annular or arched lesions on the face, with slight central atrophy and
photosensitivy, clinically and histologically similar to subacute cutaneous lupus.
However, in some cases, the lesions may resemble those in cutis marmorata
telangiectatica congenita, although this phenomenon is rare and only eight such cases
have been reported to date. We report a case of cutaneous neonatal lupus with
atypical lesions on the limbs, which had a reddish-purple marbled appearance,
resembling the lesions in cutis marmorata telangiectatica congenita.
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Abstract
A 6-week-old, otherwise healthy boy presented to the dermatology clinic for evaluation of an eruption involving his scalp, face, and trunk. The truncal lesions had been present for several weeks, and the facial and scalp lesions were noticed 5 days prior to presentation. The eruption was asymptomatic without scratching or discomfort noted by his mother. Past medical history was remarkable for preterm delivery due to maternal hypertension during pregnancy. The infant was thriving and gaining weight appropriately. There was no family history of cutaneous or autoimmune disease. No one in the family had a recent tinea infection. On physical exam, he was a well-appearing, vigorous infant. There were multiple erythematous papules and annular plaques involving his left pre-auricular and post-auricular areas, scalp, upper chest, and right abdominal wall (Figures 1 and 2). No other cutaneous or mucus membrane lesions were noted. His cardiac, lung, and abdominal exams were normal.
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19
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Femia A, Vleugels RA. Pediatric Autoimmune Connective Tissue Diseases: An Update on Disease Characteristics, Associations, and Management. CURRENT DERMATOLOGY REPORTS 2013. [DOI: 10.1007/s13671-013-0058-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Heelan K, Watson R, Collins SM. Neonatal lupus syndrome associated with ribonucleoprotein antibodies. Pediatr Dermatol 2013; 30:416-23. [PMID: 23432184 DOI: 10.1111/pde.12088] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Neonatal lupus erythematosus (NLE) is a rare acquired autoimmune disease caused by transplacental transfer of maternal immunoglobulin G antibodies to the fetus. NLE has well-recognized cutaneous features and may also manifest in other organs. The majority of cases are associated with Ro/SSA and La/SSB antibodies. Neonatal lupus due to antiribonucleoprotein (RNP) antibodies has rarely been reported. On rare occasions RNP has been found in association with other antibodies. We report a case of NLE occurring solely due to RNP antibodies presenting as varicelliform lesions at birth. We recorded the features in our case and 14 additional cases identified in the literature. It is important to recognize that maternal transfer of RNP antibodies may produce the classic cutaneous features of neonatal lupus. The limited case reports of this condition suggest that manifestations are limited to the skin; specifically, there are no reports of cardiac involvement. The long-term outcome remains unknown. RNP-positive, Ro/La-negative NLE seems to represent a different clinical subset of NLE. The recognition of RNP antibody NLE as a benign condition limited to the skin is helpful in planning antenatal care for subsequent pregnancies.
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Affiliation(s)
- Kara Heelan
- Department of Dermatology, Our Lady of Lourdes Hospital, Drogheda, Ireland.
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21
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Lee SH, Roh MR. Targetoid lesions and neutrophilic dermatosis: an initial clinical and histological presentation of neonatal lupus erythematosus. Int J Dermatol 2013; 53:764-6. [DOI: 10.1111/j.1365-4632.2012.05680.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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22
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Frey MN, Ioppi AEE, Garbin GC, Furian RD, Bau AEK. Congenital and neonatal lupus erythematosus: two case reports. An Bras Dermatol 2012; 87:625-8. [PMID: 22892781 DOI: 10.1590/s0365-05962012000400019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Accepted: 08/30/2011] [Indexed: 11/22/2022] Open
Abstract
Neonatal lupus erythematosus is an autoimmune disease produced by the passage of maternal antinuclear antibodies and extractable nuclear antigen antibodies through the placenta. At the moment of the diagnosis, the mothers are asymptomatic in 40 to 60% of cases. The most common manifestations are cutaneous lesions and congenital heart block. The cutaneous findings are variable and usually begin within the first weeks or months of life. Congenital lupus erythematosus is a congenital variant of neonatal lupus erythematosus. We present one case of congenital lupus erythematosus and one case of neonatal lupus erythematous, showing the variability of this disease.
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Affiliation(s)
- Marcos Noronha Frey
- Dermatology Service, Federal University of Health Sciences, Porto Alegre, RS, Brazil
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23
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Sharon VR, Konia TH, Barr KL, Fung MA. Assessment of the 'no eosinophils' rule: are eosinophils truly absent in pityriasis lichenoides, connective tissue disease, and graft-vs.-host disease? J Cutan Pathol 2012; 39:413-8. [PMID: 22443393 DOI: 10.1111/j.1600-0560.2012.01891.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Eosinophils are often present in the inflammatory infiltrate of an interface dermatitis, but the diagnostic specificity of eosinophils in interface dermatitis has not been formally evaluated. We retrospectively identified 97 examples of interface dermatitis with clinically confirmed diagnoses, including lupus erythematosus (LE), lichen planus, pityriasis lichenoides (PL), graft-vs.-host disease (GVHD), dermatomyositis (DM) and drug reaction. Diagnoses were clinically confirmed by at least two dermatologists. Slides were reviewed in a blinded fashion by at least two dermatopathologists. The average eosinophil count per 10 ×200 (×20 objective) fields was lowest for PL (0.2), DM (0.3), GVHD (0.4), and LE (0.5) [defined as Group 1] and was higher for lichen planus, drug reactions, erythema multiforme (major and minor) and viral exanthems [defined as Group 2]. Distinction between Group 1 and Group 2 was maximized using an eosinophil count cutoff of 1.1. In conclusion, eosinophils are usually rare to absent in PL, DM, most forms of LE and GVHD. While final interpretation requires a composite assessment of all features, our results suggest that the presence of even a single eosinophil within nine or ten ×20 fields argues against a diagnosis of PL, DM or LE.
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Affiliation(s)
- Victoria R Sharon
- Department of Dermatology, University of California Davis, Sacramento, CA, USA
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Almpanis GC, Kounis GN, Mazarakis A, Kounis NG. Coronary artery spasm progressing to acute myocardial infarction in patients with systemic inflammatory disease: a potential association with Kounis syndrome. Int J Cardiol 2011; 151:1-2. [PMID: 21703697 DOI: 10.1016/j.ijcard.2011.06.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Accepted: 06/06/2011] [Indexed: 11/30/2022]
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25
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Abstract
Neonatal lupus erythematosus (NLE) is characterized by the transplacental passage of maternal anti-Ro and/or anti-La antibodies and characteristic illnesses in the foetus/neonate. Most attention has focused on the most serious complication- cardiac involvement. This article will focus on non-cardiac involvement. Skin involvement (cutaneous NLE) is present in 15-25% of children with NLE. The rash of NLE tends to be photosensitive but may be present at birth or in non-sun exposed areas. It is most frequently seen around the eyes, not in the malar area, but also occurs in other parts of the body. The pathology resembles the rash of subacute cutaneous lupus erythematosus. Anti-Ro antibodies are present in >95% with the remaining mothers having anti-U1RNP antibodies only. Asymptomatic elevation of liver function tests, which may be associated with evidence of cholestasis, is seen in 10-25% of cases of NLE. Mild hepatomegaly and less commonly splenomegaly may be present. Liver involvement seen in isolation or associated with other features. The pathology resembles idiopathic neonatal giant cell hepatitis. Any haematological lineage, neutropenia and thrombocytopenia most commonly, may be affected by NLE. Haematological involvement is almost always asymptomatic. There are protean manifestations of neurologic involvement in NLE: hydrocephalus, non-specific white matter changes, calcification of the basal ganglia and a 'vasculopathy'. The most unusual feature of NLE is the radiographic finding of stippling of the epiphyses (chondrodysplasia punctata). Overall, non-cardiac involvement of NLE is more common than cardiac. The study of these manifestations may lead to new insight into how autoantibodies lead to disease.
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Affiliation(s)
- E Silverman
- Division of Rheumatology, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
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27
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Sepehr A, Wenson S, Tahan SR. Histopathologic manifestations of systemic diseases: the example of cutaneous lupus erythematosus. J Cutan Pathol 2010; 37 Suppl 1:112-24. [PMID: 20482683 DOI: 10.1111/j.1600-0560.2010.01510.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Alireza Sepehr
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
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