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LETTER TO EDITOR
Year : 2017  |  Volume : 18  |  Issue : 1  |  Page : 60-61

Harlequin color change in a neonate with meningitis


Department of Pediatric Medicine, R. G. Kar Medical College, Kolkata, West Bengal, India

Date of Web Publication12-Dec-2016

Correspondence Address:
Pradipprava Paria
Department of Pediatric Medicine, R. G. Kar Medical College, 1, Kshudiram Bose Sarani, Kolkata - 700 004, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2319-7250.188455

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How to cite this article:
Paria P, Gayen S, Mondal PC, Das GC. Harlequin color change in a neonate with meningitis. Indian J Paediatr Dermatol 2017;18:60-1

How to cite this URL:
Paria P, Gayen S, Mondal PC, Das GC. Harlequin color change in a neonate with meningitis. Indian J Paediatr Dermatol [serial online] 2017 [cited 2019 Dec 8];18:60-1. Available from: http://www.ijpd.in/text.asp?2017/18/1/60/188455



Sir,

Harlequin color change (HCC) represents a idiopathic phenomenon where there is a sudden change in skin color, often with a distinct edge along midline of the body, dividing neonate body skin into a pale half and a plethoric half. Occasionally, the line of demarcation may be incomplete, sparing the face and genitalia. Changing the infant's position may reverse the pattern.[1] It usually resolves within minutes without any treatment. Repeated episodes may also occur. We here present a neonate suffering from meningitis with HCC.

A preterm, 33 weeks gestation male neonate was born by emergency cesarean section for prolonged rupture of membrane (>48 h) and nonprogression of labor. After birth, he had developed respiratory distress (Downe score-5) and was put on intravenous fluid, oxygen, and prophylactic antibiotic with ampicillin and gentamycin. At day 3 of life, he developed features of sepsis. We had changed the antibiotic. Despite that on day 4, a focal clonic seizure was occurred. It was followed by a transient erythematous rash on the left side of the trunk. The right side was relatively paler and rest of the body color was normal [Figure 1]. The rash rapidly vanished within 2 min from its appearance. Later, the baby was diagnosed as a case of meningitis. Blood culture shows the growth of Klebsiella. We had treated accordingly and discharged the baby after 24 days of life.
Figure 1: Distinct erythema over left side of trunk along with a demarcation line with right side, which is relatively paler in appearance

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HCC is a benign, idiopathic phenomenon, appears transiently in new borns, on days 2–5 of life. To date, few reports of this condition have appeared in the literature, due to its transience. It is seen most often in healthy neonates. Occasional reports are there with prematurity, low birth weight, hypoxia, and systemic use of prostaglandin E1 or intracranial injury.[2] Our case is the second one in literature where HCC occurs in neonate suffering from meningitis.[3] HCC can also be associated with congenital or acquired lesions of hypothalamus, brain stem, cervical sympathetic nervous system, or of the second and third spinal cord thoracic segments.[4] It is thought that hypothalamic immaturity causes temporary imbalance in the tone of cutaneous blood vessels leading to this type of phenomenon.[5] Therefore, erythematous areas result due to unregulated regional capillary vasodilatation and pale areas results from regional vasoconstriction. The differential diagnosis includes port-wine stain and nascent hemangioma of infancy.[6] The transient nature of HCC helps to differentiate it from these other conditions.

In conclusion, all physicians should recognize its characteristic appearance to avoid unnecessary investigations and medications to treat it.

Declaration of Patient Consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial Support and Sponsorship

Nil.

Conflicts of Interest

There are no conflicts of interest.

 
  References Top

1.
Wright DR, Cohen BA. Common newborn dermatoses. In: Gleason CA, Devaskar SU, editors. Avery's Disease of the Newborn. 9th ed. Philadelphia: Elsevier; 2013. p. 1403.  Back to cited text no. 1
    
2.
Valerio E, Barlotta A, Lorenzon E, Antonazzo L, Cutrone M. Harlequin color change: Neonatal case series and brief literature review. AJP Rep 2015;5:e73-6.  Back to cited text no. 2
    
3.
Lee RS, Wan HS, Chan RL. Harlequin colour change in a newborn with meningitis. Hong Kong Med J 2012;18:539.e3-4.  Back to cited text no. 3
    
4.
Januário G, Salgado M. The Harlequin phenomenon. J Eur Acad Dermatol Venereol 2011;25:1381-4.  Back to cited text no. 4
    
5.
Padda GS, Cruz OA, Silen ML, Krock JL. Skin conductance responses in paediatric Harlequin syndrome. Paediatr Anaesth 1999;9:159-62.  Back to cited text no. 5
    
6.
Cordoro KM, Speetzen LS, Koerper MA, Frieden IJ. Physiologic changes in vascular birthmarks during early infancy: Mechanisms and clinical implications. J Am Acad Dermatol 2009;60:669-75.  Back to cited text no. 6
    


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