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Aplastic anemia in neonatal lupus erythematosus
1Department of Pediatrics, Meir General Hospital, Sapir Medical Center, Kfar Saba, Israel.
Objective:
To describe an infant with neonatal lupus erythematosus associated with aplastic anemia.
Setting:
The pediatric department in a tertiary-care hospital.
Interventions:
Packed red blood cell transfusions and a 3-week course of high-dose steroid therapy.
Measurements/Main Results:
The patient presented with severe anemia and a circumscribed, reticular, macular rash on the face and neck at 5 months of age. Skin lesion biopsy revealed epidermic hyperkeratosis, hydropic degeneration of the basal layer, and deposition of immunoglobulins and granular C1q at the dermoepidermal junction. Ro/SS-A antibodies were present in the infant. BFU-E (erythroid progenitor burst-forming unit) colonies in bone marrow increased by about tenfold when suppressor CD8+ T lymphocytes were removed, indicating immune suppression of hematopoiesis. High-dose steroid therapy failed. The infant subsequently developed gram-negative sepsis, severe metabolic acidosis, and consumptive coagulopathy and died.
Conclusions:
Neonatal lupus erythematosus may present as part of a spectrum. The disease may range from mild and transient to a severe, life-threatening condition requiring immediate intervention, as in the case reported here. This is the first report of neonatal lupus associated with aplastic anemia due to immune-mediated suppression of hematopoiesis.