History:

Patient of Dr 

4 weeks old baby brought in by the parent concerning the rash on his face and chest.
The rash has started about a week ago.
otherwise the baby is fine. nil major concerns. appetite and thriving well.

The rash was treated as ring worm with antifungal cream.

The rash is red non scaly quite thick and raised border well defined with central clearing.
Distribution a side of face and chest.
Palpation of the rash does not seem to upset the baby.

baby is afebrile, chest clear and heart sounds is normal with no added sound.

Meanwhile the mother has history of Hashimoto's thyroiditis and at early stage of pregnancy presented with a few occasions of swelling parotid glands which then diagnosed with Sjogren's syndrome. She has positive Ana and  anti Ro and La.

I did not do any investigation, it just came to me this is not ring worm as the amount of rash is quite a lot and came up within short of time.

the baby was referred to his paediatrician.

Very good pick up Rozi! This is a classic presentation of neonatal lupus in a mother who is Ro antibody positive. Topical steroid and sunscreens . If no heart block it will settle ok as mothers transmitted antibody level drops. (Submitted By: Dr Ian McColl)

You also have to warn mother that subsequent pregnancy is at higher risk for developing complications such as heart block. I have had a few patients like this and when they get pregnant again the unborn baby needs to be watched intrauterine for development of heart block by specialists who try to look out for it in Utero. As far as I know if one child gets neonatal lupus it increases the likelihood of future problems in subsequent pregnancies. (Submitted By: Dr Claire Poolman)