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British Journal of Healthcare and Medical Research - Vol. 9, No. 1
Publication Date: February, 25, 2022
DOI:10.14738/jbemi.91.11869. Aamri, H., Hazzab, N., Bennaoui, F., Slitine, N. E. I., & Maoulainine, F. M. R. (2022). Neonatal Lupus: 5 Pediatric Cases. British Journal
of Healthcare and Medical Research, 9(1). 166-171.
Services for Science and Education – United Kingdom
Neonatal Lupus: 5 Pediatric Cases
Aamri H.
Neonatal intensive care unit, Mother-Child Hospital
CHU Mohammed VI, Marrakech, Morocco
Childhood, Health and Development Research Unit
Faculty of Medicine, Cadi-Ayyad University, Marrakech, Morocco
Hazzab N.
Neonatal intensive care unit, Mother-Child Hospital
CHU Mohammed VI, Marrakech, Morocco
Childhood, Health and Development Research Unit
Faculty of Medicine, Cadi-Ayyad University, Marrakech, Morocco
Bennaoui F.
Neonatal intensive care unit, Mother-Child Hospital
CHU Mohammed VI, Marrakech, Morocco
Childhood, Health and Development Research Unit
Faculty of Medicine, Cadi-Ayyad University, Marrakech, Morocco
N. El Idrissi Slitine
Neonatal intensive care unit, Mother-Child Hospital
CHU Mohammed VI, Marrakech, Morocco
Childhood, Health and Development Research Unit
Faculty of Medicine, Cadi-Ayyad University, Marrakech, Morocco
Maoulainine F. M. R.
Neonatal intensive care unit, Mother-Child Hospital
CHU Mohammed VI, Marrakech, Morocco
Childhood, Health and Development Research Unit
Faculty of Medicine, Cadi-Ayyad University, Marrakech, Morocco
ABSTRACT
Neonatal lupus erythematosus is a rare condition that manifests itself in different
types of damage, whether cutaneous, hepatic, hematological, neurological or even
cardiac. We report here five cases of neonatal lupus occurring in newborns, two of
them from completely asymptomatic mothers and revealed by cardiac involvement
and one case revealed by skin involvement.
Key words: Neonatal lupus erythematosus; congenital heart block; newborn; antinuclear
antibodies
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167
Aamri, H., Hazzab, N., Bennaoui, F., Slitine, N. E. I., & Maoulainine, F. M. R. (2022). Neonatal Lupus: 5 Pediatric Cases. British Journal of Healthcare
and Medical Research, 9(1). 166-171.
URL: http://dx.doi.org/10.14738/jbemi.91.11869
INTRODUCTION
Neonatal lupus erythematosus is manifested by cutaneous, hematological, hepatic or cardiac
involvement including possible congenital atrioventricular block (BAVc) occurring in a heart
free from malformative heart disease, dilated cardiomyopathy and endocardial fibroelastosis.
This rare syndrome is consistently associated with the presence in the mother of anti-SSA / Ro
and / or anti-SSB / La antibodies. Skin involvement has been rarely reported in association with
the isolated anti-RNP antibody.
Cutaneous and systemic damage is transient, unlike cBAV which is definitive and is associated
with morbidity and mortalitywhichmakethis syndrome soserious.
We report five observations of LN occurring in newborns (NB) including two from completely
asymptomatic mothers and one newborn from a motherfollowed for Gougerot-Sjögren
syndrome.
OBSERVATIONS
Observation 1
A femal newborn, from a 37-year-old mother with no pathological history. Poorly monitored
pregnancy conducted at 34 weeks. Cesarean delivery for extreme fetal bradycardias. Having
presented at birth with neonatal respiratory distress associated with bradycardia at 65b / min,
a complete assessment was carried out, a complete blood count objectifying anemia at 11.1g /
dl, without leukopenia or thrombocytopenia. A correct hepatic and renal workup and positive
anti-nuclear antibodies, positive anti-SSA (Ro52 and Ro60) and positive anti-RNP. A chest x-ray
objectified an aspect in favor of an early neonatal infection with pulmonary localization. An ECG
objectified a 3rd degree AVB. A cardiac ultrasound showed a muscle VIC of 2 mm, an
aneurysmaloval foramen. The evolution was marked by the appearance of cutaneous
involvement at the age of 1 and a half made of a butterfly wing erythema of the face. The mother
has a stable antibody level with no associated clinical manifestations.
Observation 2
A male nexborn, from a 42-year-old mother, with the notion of 1st degree consanguinity, having
a miscarriage as a history. Resulting from a well-followed pregnancy and carried to term and
delivery by cesarean section for suspected heart disease due to fetal bradycardia. The newborn
presented at birth a bradycardia at 50 b / min associated with respiratory distress on the 2/10
side according to the silverman score for which he was hospitalized in neonatal intensive care.
A complete workup was carried out with a normal blood count, a renal and hepatic workup
without abnormality and anti-nuclear antibodies positive to 1/320 of the speckled type, anti- SSA (Ro52 and Ro60) positive. An ECG objectified a 3rd degree AVB. A chest x-ray objectified
cardiomegaly with an ICT of 0.64. A cardiac ultrasound showed a very altered global and
segmental contractility, a foramen ovale versus CIA and a membrane on the aortic arch
suggesting a coarctation of the aorta. The course was marked by the worsening of his
bradycardia and his respiratory distress. The newborn died after a four-day stay in intensive
care. The mother was diagnosed at this age and currently followed with stable immunological
and clinical status.
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British Journal of Healthcare and Medical Research (BJHMR) Vol 9, Issue 1, February - 2022
Services for Science and Education – United Kingdom
Observation 3
A male newborn, from a normal pregnancy carried to term, and a mother followed for suspected
lupus in front of rheumatoid purpura + dry syndrome + positive ANA with anti-SSA and anti- SSB positive. Hospitalized in neonatal intensive care at day 6 of life for a postnatal infection
before: thrombocytopenia and a positive CRP. An infectious assessment was performed
showing a urinary tract infection with Escherichia Coli. Put on antibiotic treatment for 10 days.
The course was marked by the persistence of thrombocytopenia and the appearance of rounded
erythematous papular lesions, covered by fine scales (figure 1). The count showed
thrombocytopenia at 58,000 with anemia of 11.5 normochromium, normocytic without
leukopenia. ECG and ETT did not show any abnormalities. NAAs are 1/640 positive with
positive anti-SSA and anti-SSB. The evolution was towards the regression of symptoms in 4
months. The mother iswatched, the hindsight is one year.
Observation 4
It is the child Nour Mallak, aged 4, asymptomatic mother. She presented for a cardiology
consultation for bradycardia. On examination, the child presented with bradycardia at 59b /
min without other associated signs, in particular no skin involvement. A lupus assessment was
requested which objectified positive anti-nuclear antibodies. The indication of a pacemaker
was asked but for lack of means not achieved. The child is stable and bradycardia is tolerated.
Figure 1: Skin involvement made up of roundederythematouspapularlesions, coveredwith fine
scales
Observation 5
A femal newborn, from a mother followed for lupus. He was hospitalized in neonatal intensive
care for fetal bradycardias + IUGR. An ECG objectified a grade 3 AVB. The AANs were positive
at 1/640 of speckled type, anti-SSA positive (Ro52 + Ro60) at 100IU / ml and anti-SSB positive
at 100IU / ml. The biological assessment, in particular the CBC and the hepatic assessment,
were normal. He presented a nosocomial infection following his hospitalization in intensive
care.