A baby was delivered by elective caesarean section at 34 weeks' gestation because of decreased intrauterine growth velocity to a non-consanguineous Chinese couple. He was found to have a widespread atrophic and ulcerative rash over his face and upper body (figure 1). Deep purple papules were noted on his feet, which resolved over days. He also developed profound thrombocytopenia requiring platelet transfusion and later developed pancytopenia. Microbiological and serological investigations (Toxoplasmosis, Rubella, Cytomegalovirus, herpes) were all negative. His mother became coagulopathic requiring product support immediately postpartum.

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Figure 1

Atrophic rash over the baby's face after birth

Skin biopsy suggested neonatal lupus, which was confirmed serologically. His mother later presented with suspected postpartum sepsis, but in view of his diagnosis, the mother wasconfirmed to have systemic lupus erythematosus. She responded well to systemic corticosteroid therapy.

The deterioration in his rash reached a nadir at 3 months of age (figure 2), and subsequently self-resolved with the passage of maternal antibodies. There was no cardiac involvement, but he exhibited transaminitis in keeping with hepatobiliary involvement.

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Figure 2

Atrophic and ulcerative rash over the baby's face at 3 months.

This case highlights postnatally diagnosed neonatal lupus, with a previously well mother, and the importance of multidisciplinary communication.