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Chondritis and arthritis; unique manifestations of neonatal lupus (case report)
  1. M Baba,
  2. V David,
  3. G Subramanian
  1. Paediatrics Department, Barking Havering and Redbridge University Hospitals NHS Trust, Romford, UK

Abstract

We report the case of a 4 week-old male infant who presented with pyrexia, left auricular chondritis (figure 1) and arthritis of the proximal interphalangeal joints of the left index finger and right great toe. It was discovered that his mother suffered from arthralgia in the previous year and was awaiting investigation results. Anti Ro (SS-A) and Anti La (SS-B) antibodies were positive both in the mother and the infant, suggesting neonatal lupus erythematosus (NLE) as an explanation for the clinical features. Apart from raised inflammatory markers no evidence of infection was found. Radiological investigations and ECG were normal. His daily spikes of pyrexia did not respond to antibiotics and lasted for nearly 2 weeks. He remained clinically well and was followed-up as out-patient. The redness and swelling resolved gradually over the next 4 weeks. Literature review revealed that although cardiac, cutaneous, hepatic, haematological and neurological disorders are recognised manifestations of NLE. Additionally a number of cases of cartilaginous disease such as chondrodysplasia punctata have been reported in association with maternal SLE.1 However, neither chonritis nor arthritis have been described as features of NLE. We have also searched in the Lupus Research Registry, which also had no reported case of NLE with chondritis or arthritis. Polychondritis and arthritis are known associations of systemic lupus erythematosus and Sjogren's syndrome.2 3 Some infants with NLE may later develop rheumatoid arthritis.4 There has also been a case report of a systemic onset juvenile idiopathic arthritis in neonatal period.5 The transient nature of the chondritis and arthritis in our case, however, makes NLE more likely. We have therefore concluded that chondritis and arthritis are possibly the unusual and rare manifestations of NLE.

Abstract G169 Figure 1

Inflammation of the pinna of the left ear with earlobe-sparing.

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