Late-onset Blueberry Muffin Lesions Following Recombinant Erythropoietin Administration in a Premature Infant

Abstract

Recombinant erythropoietin is being used in premature population for anemia of prematurity. It is considered very safe in this population, although risks are still being evaluated. We report the first case of dermal erythropoiesis as a side effect of recombinant erythropoietin in an extremely prematurely born infant presenting with late-onset blueberry muffin lesions.

Fetal hypoxia secondary to severe maternal anemia as a causative link between blueberry muffin baby and erythroblastosis: a case report

“…The worsening maternal anemia secondary to recurrent vaginal bleeding (hemoglobin values <6 g/L at least twice during pregnancy) required multiple administrations of RBC transfusions: this maternal treatment may have created a fluctuating hypoxic state in the fetus, resulting in additional and sequential stimuli for EPO production and consequent NRBC release. Confirming these observations, two cases of blueberry muffin lesions following recombinant EPO administration in premature neonates have recently been reported [ 11 , 12 ].…”

Preterm infant with a late presentation of blueberry muffin lesions secondary to recombinant erythropoietin

“…Late-onset blueberry muffin lesions and dermal hematopoiesis have only been reported twice in neonates, once in a case report of a congenital rubella syndrome and the other as a result r-EPO administration [1,5]. To our knowledge there is only one published report of rEPO-induced blueberry muffin lesions other than the case we present here [5]. Our patient was a female born at 26 weeks gestational age that developed non-blanching erythematous macules on the back at 8 weeks of age after her 8 th dose of r-EPO.…”