Neonatal Lupus
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A baby boy born to apparently healthy parents had a bright red rash over his face within 2 hours after birth (Panel A). He also had clinical features consistent with trisomy 21, which was confirmed by karyotyping. The initial laboratory tests showed a haemoglobin level of 14 g per deciliter and a platelet count of 24,000 per cubic millimeter. An electrocardiogram at 4 weeks of age showed normal sinus rhythm, and the rash was reduced (Panel B). A complete blood count showed a white-cell count of 4500 per cubic millimeter with a normal differential count; the haemoglobin level was 8.8 g per deciliter, the platelet count 79,000 per cubic millimeter, the aspartate aminotransferase level 108 U per liter, and the alanine aminotransferase level 115 U per liter. Serologic testing by means of a multiplex bead assay was strongly positive for SSA (Ro) and SSB (La) , confirming the diagnosis of neonatal lupus. By the time the patient was 6 months old, the rash had resolved without specific therapy (Panel C), and the levels of haemoglobin, platelets, and liver enzymes had normalized...

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