Table 1 Differential diagnosis of immune mediated disorders presenting with neurological symptoms and skin lesions
From: A newborn with grouped facial skin lesions and subsequent seizures
| Â | Clinical characteristics in newborn patients with skin and neurological lesions | ||
|---|---|---|---|
Diagnosis | Skin | Neurological characteristics | Serological characteristics |
Neonatal Herpes Simplex Virus 1 (HSV1) | vesiculopustular lesions | seizures, tremors, lethargy | HSV1-IgM antibodies positive |
Congenital Varicella Syndrome (VZV) | skin rashes, papules, vesiculopustular lesions, crusts | seizures | VZV-IgM antibodies positive |
Herpes Zoster (HZ) | skin rash, vesicles, crusts, limited to a dermatome | seizures | VZV-IgM antibodies positive |
Neonatal Lupus Erythematosus (NLE) | malar rash or butterfly rash, scaly patches, skin and mucosa lesion like ulcers | seizures | ANA, anti- Sm antibodies, SSA/Ro and SSB/La antibodies, anti-U1-RNP antibodies |
Mixed Connective Tissue Disease (MCTD) | rash, scaly patches, overlapping symptoms of SLE, PSS, PM and RA | - | ANAs, anti-U1-RNP antibodies, (anti-Sm antibodies) |
Undifferentiated Connective Tissue Disease (UCTD) | malar rash, oral ulcers purpura, urticaria | seizures, neuropathy | ANA, anti-Ro/SSA, anti-Sm-, anti-ds DNA-, anti RNP-, anti-Ku antibodies, rheumatoid factor |
Antiphospholipid Syndrome (APS) | skin ulcers | seizures, strokes, abnormal movements | antiphospholipid antibodies, β2- glycoprotein- 1 antibodies, anticardiolipin antibodies |
Incontinentia Pigmenti (IP) | blistering, a wart-like rash, hyper/hypopigmentation | cerebral atrophy, seizures, slow motor development, muscle weakness | NEMO IKBKG gene (chromosomal locus Xq28), females skewed X-Chromosome inactivation |
Erythema Multiforme (EM) | pink-red blotches, target lesions | seizures (caused by HSV) | viral, bacterial or fungal infection |
Neonatal Acne (NA) | comedones, papules, pustules | - | Malassezia species |
Langerhans Cell Histiocytosis (LCH) | scaly erythematosus lesions, red papules, eruptions on the scalp | - | Â |
Impetigo Contagiosa (IC) | honey yellow crusts, plaques or bullae | - | Staphylococcus aureus, beta-hemolysing Streptococcus, group A |
Congenital Syphilis(CS) | pemphigus syphiliticus | seizures, pseudoparalysis | Treponema pallidum |