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Congenital rubella syndrome with rubella virus-associated generalized brownish macules, indurated erythemas, papules,
1Department of Dermatology, Okayama University Medical School, Japan.
Insights
Congenital rubella syndrome (CRS) can present with distinctive skin lesions. This case highlights prominent cutaneous manifestations as key indicators of rubella virus infection in infants.
Area of Science:
- Pediatric Dermatology
- Viral Infections
- Immunology
Background:
- Congenital rubella syndrome (CRS) is a significant concern in infants born to mothers infected during pregnancy.
- Rubella virus infection during gestation can lead to a spectrum of developmental abnormalities.
Observation:
- A 7-month-old infant presented with widespread skin lesions including brownish macules, indurated erythemas, papules, and pigmentation, appearing around 3 months of age.
- The infant exhibited other CRS-related symptoms such as deafness, developmental delays, interstitial pneumonitis, and hepatosplenomegaly.
- Rubella-specific IgM antibodies were detected in the infant's serum and cerebrospinal fluid.
Findings:
- Skin biopsy revealed dense lymphocytic infiltration with B cells in the deep dermis.
- Electron microscopy identified tubuloreticular structures in capillary endothelial cells, lymphocytes, and dermal fibroblasts.
- Polymerase chain reaction (PCR) confirmed the presence of rubella virus RNA in skin, cerebrospinal fluid, and blood samples.
Implications:
- The described cutaneous manifestations are significant and should be recognized as potential markers for congenital rubella syndrome.
- Early identification of these skin lesions can aid in the diagnosis and management of CRS.
- This case underscores the importance of considering rubella virus in the differential diagnosis of infantile dermatoses with systemic involvement.
Background:
We examined an infant with congenital rubella syndrome (CRS). The purpose of this report is to describe the skin manifestations in this patient and to prove that they were associated with rubella virus.
Observations:
A 7-month-old boy presented with generalized brownish macules, indurated erythemas, papules, and pigmentation. They first appeared at around 3 months of age. His mother had contracted rubella during the 14th gestational week. At the time of examination, rubella-specific IgM antibody was positive in both serum and cerebrospinal fluid of the baby. A physical exam had revealed deafness, mental and physical retardation, interstitial pneumonitis, and hepatosplenomegaly. A skin biopsy specimen showed a dense infiltration mainly of lymphocytes, with B cells predominant in the deep dermis. Electron microscopically abundant tubuloreticular structures were observed in capillary endothelial cells, lymphocytes, and dermal fibroblasts. Polymerase chain reaction (PCR) analysis suggested that rubella virus RNA was present in the patient's skin specimen, cerebrospinal fluid, and total blood.
Conclusions:
The cutaneous manifestations of our patient were extraordinary and informative. These prominent skin lesions should be recognized as cutaneous markers of CRS.