A 6 month old infant was seen by doctors on the 16th July at one of our mobile medical clinics in rural Zambia. The rash developed 1 week before attending clinic. Some lesions were crusting and the rash was present on the face, arms, back and buttocks. The rash did not appear to be bothering the infant and there was no fever or systemic symptoms. The infant was otherwise fit and well, HIV negative and had been seen previously by our doctors at which time there was no evident rash. This rash had been treated by the community health worker with IM benzylpenicillin with some effect.
We sent the case to a Professor specialising in Paediatric Dermatology from the USA.
“This very prominent facial rash with an overall annular scaly appearance and impressive hypopigmentation is characteristic of NEONATAL LUPUS ERYTHEMATOSIS, a rare disorder in which infants have maternal antibodies (SS-A, SS-B sometimes called Ro and La antibodies, rarely RNP antibodies) which are photosensitizing so the rash appears after sun exposure. The rash will fade in time as the infant clears maternal antibodies but sun protection is important until this occurs. Scarring is unlikely. Topical hydrocortisone 1% or 2.5% ointment or Cream applied twice daily is safe and should result in improvement although return of normal pigmentation will likely take many months. Sunscreens and/or complete sun avoidance is strongly recommended until this occurs. The most IMPORTANT ASPECT of NLE is the possibility of CONGENITAL HEART BLOCK which is often complete and can be fatal. When NLE is suspected an EKG as soon as possible after delivery is key. In this infant who appears to be thriving and has reached the age of 6 months, heart block is less likely but EKG is still recommend. Other organ systems can be involved causing, among other things, anemia and liver enzyme elevations. Mothers of infants with NLE are more often than not asymptomatic and unaware of the presence of antibodies. There is a high risk of NLE in subsequent pregnancies. Serologies may not be available for this infant but I hope an EKG can be arranged. This is an absolutely fascinating case and I am so pleased to review it.”
7 messages were exchanged between referring doctor, Consultant and Swinfen System operator saving approx. £1400 as Swinfen Telemedicine service is FREE.
“Brilliant case which beautifully illustrates just why Swinfen Telemedicine is making such an important contribution to world health one person at a time. Love this!”
Dr. A. Howland Hartley, MD, FAAP, FAAD, Swinfen Consultant