Neonatal Lupus Syndrome Associated with Ribonucleoprotein Antibodies

Abstract

Neonatal lupus erythematosus (NLE) is a rare acquired autoimmune disease caused by transplacental transfer of maternal immunoglobulin G antibodies to the fetus. NLE has well-recognized cutaneous features and may also manifest in other organs. The majority of cases are associated with Ro/SSA and La/SSB antibodies. Neonatal lupus due to antiribonucleoprotein (RNP) antibodies has rarely been reported. On rare occasions RNP has been found in association with other antibodies. We report a case of NLE occurring solely due to RNP antibodies presenting as varicelliform lesions at birth. We recorded the features in our case and 14 additional cases identified in the literature. It is important to recognize that maternal transfer of RNP antibodies may produce the classic cutaneous features of neonatal lupus. The limited case reports of this condition suggest that manifestations are limited to the skin; specifically, there are no reports of cardiac involvement. The long-term outcome remains unknown. RNP-positive, Ro/La-negative NLE seems to represent a different clinical subset of NLE. The recognition of RNP antibody NLE as a benign condition limited to the skin is helpful in planning antenatal care for subsequent pregnancies.

Lupus eritematoso neonatal. Reporte de caso de lactante concebida por inseminación artificial y madre con artritis reumatoidea

“…El Lupus Eritematoso Neonatal afecta aproximadamente del 10 % al 20 % de los nacidos de madre con anticuerpos anti-Ro y anti-La que no han sido diagnosticadas de Lupus, síndrome de Sjögren o síndrome autoinmune indiferenciados con anticuerpos circulantes 1,12 . Los anticuerpos maternos anti-Ro y anti-La son transferidos a través de la placenta 2,7,11 . Los anticuerpos anti-Ro se encuentran usualmente en el síndrome de Sjögren, pero se pueden encontrar en un 30 % en pacientes con lupus eritematoso sistémico con características cutáneas 3,6 .…”

Congenital Lupus with Multiorgan Involvement: A Case Report and Review of Literature

“…Multisystem involvement is uncommon . Similar to NLE, approximately half of mothers with CLE are asymptomatic at the time of diagnosis, most typically with anti‐Ro or ‐La antibodies but occasionally with anti‐U1 ribonucleoprotein antibodies .…”

“…The literature contains several case reports of CLE, but only two reports with a significant review of patients. Several references include cases that appear to be bona fide CLE . A case series by Weston et al described 18 patients and emphasized that cutaneous lesions in NLE appeared in the first months of life, although only 3 of the 18 had skin involvement at birth.…”

“…The literature contains several case reports of CLE, but only two reports with a significant review of patients. Several references include cases that appear to be bona fide CLE (1)(2)(3)(4)(5)(6)(7)(8)(9)(10) et al (11) described 18 patients and emphasized that cutaneous lesions in NLE appeared in the first months of life, although only 3 of the 18 had skin involvement at birth. Kaneko et al (12) described 60 newborns with NLE and noted the congenital presence of skin disease in 18% to 23% ( Table 1).…”

Neonatal lupus erythematosus: the use of telephone images in diagnosis

“…Almost all babies (95%) with NLE have anti-Ro antibodies 5 although an association with RNP antibodies has been reported in 15 Ro/La-negative cases; in the latter the disease was limited to the skin. 6 A case was reported of dizygotic twins who were exposed to the same in utero environment, but only one developed NLE, highlighting that existence of maternal autoantibodies alone is insufficient to induce the clinical features of NLE. Ultraviolet (UV) radiation is not essential for the pathogenesis of NLE but is probably one of several causal mechanisms for the development of cutaneous lesions.…”