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Figure?6 Scaly lesions in the feet. At follow-up, the skin lesions resolved within 1?year, leaving hyperpigmented macules on the trunk (figure 7). Neurodevelopment was normal. At the cardiology consultation (2?months), the hyperechogenic lesions disappeared, but he was diagnosed with moderate mitral insufficiency with diuretics needs until nowadays. Figure?7 Hyperpigmented macules in the trunk. The mother was referred to an autoimmune consultation, where she was diagnosed with Sjogren syndrome. Discussion The most common clinical manifestations of NLE are in decreasing order of frequency�C�C dermatological, cardiac and hepatic abnormalities. Some infants may also have haematological,

neurological or splenic abnormalities.1 Cutaneous lesions most often appear within the first few weeks of life and less frequently at birth. Typical rashes are erythematosus or polycystic plaques with or without fine scales�C�C predominately on the scalp, neck or face (with a periorbital distribution), but similar plaques may appear on the trunk and extremities. The lesions can be urticarial, desquamative, ulcerative or crusted.1 There are some uncommon skin lesions in children with NLE: multiple morphea, papulo-erythematosus rash, congenital cutaneous lupus with atrophic lesions.2 Although rare, cutaneous manifestations of lupus with nodules/papules

on the palmar and plantar meprobamate surfaces has already been described in the literature, in two reports.3 4 In our case, cutaneous manifestations were atypical: the presence of nodules/papules on hands and feet is unusual, similarly to the presence of skin rash at birth. In some cases, solar exposure seems to precipitate the eruption. The lesions last for weeks or months and then resolve spontaneously coincident with the disappearance

of maternal antibodies. Hypopigmentation or hyperpigmentation is frequent, and occasionally atrophic lesions and scars may develop.1 2 The most commonly reported manifestation of neonatal lupus is cardiac disease, with third-degree heart block being the most common finding. Cardiac manifestations usually dictate the prognosis of NLE. Other cardiovascular manifestations of NLE have been more recently recognised: atrial and ventricular arrhythmias and other conduction abnormalities, myocarditis, cardiomyopathy often with endocardial fibroelastosis and structural heart disease, particularly valvular lesions.5 These last lesions evolved stenosis, regurgitation and dysplasia. Some authors speculate that these lesions can be caused by inflammation and fibrosis. The hyperechogenic lesions on the anterior papilar muscle of the left ventricle, as seen in our case, could be a fibrotic scar resulting from some type of inflammation during the fetal period, leading posteriorly to mitral insufficiency.
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