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Indian J Pediatr DOI 10.

1007/s12098-012-0782-0

SCIENTIFIC LETTER TO THE EDITOR

Congenital Rubella Syndrome


Meenu Pandey & Ajay Dudeja & Vikram Datta & Bhupesh Singla & Arvind Saili

Received: 26 December 2011 / Accepted: 10 May 2012 # Dr. K C Chaudhuri Foundation 2012

Sir, Congenital Rubella Syndrome (CRS) is a transplacentally acquired rubella infection which leads to multiple organ defects. We are presenting three babies with CRS diagnosed within a span of 2 mo. The first patient was a premature (35 wk), baby girl born with an Apgar score (AS) of 7, 8. On day one, she had bluish-purplish papulo-nodular, non blanchable and non tender rash over the cheeks, trunk and upper limbs (Fig. 1). The rash was identified as blueberry muffin rash and confirmed on skin biopsy. She was diagnosed with CRS. The echocardiogram showed mild valvular pulmonary stenosis (PS) with a patent foramen ovale. The baby was discharged on day 18. She has been followed till the age of 2 y and is presently having global developmental delay. She has been referred to the ENT department for hearing impairment. The second patient was a preterm (34 wk) baby (AS 8, 9), who also had blueberry muffin rash on day 1. He also had a small patent ductus arteriosus (PDA). He was diagnosed as CRS. The baby was discharged on day 16. The third patient was a term baby boy, born vaginally (AS 7, 9). At birth, this baby had bilateral corneal opacities, diagnosed as
A. Dudeja : V. Datta : A. Saili Division of Neonatology, Department of Pediatrics, Lady Hardinge Medical College and associated Kalawati Saran Childrens Hospital, New Delhi, India M. Pandey (*) : B. Singla Department of Pediatrics, Lady Hardinge Medical College and associated Kalawati Saran Childrens Hospital, New Delhi 110001, India e-mail: dr_meenu_pandey@yahoo.com

buphthalmos (Fig. 2). The echocardiogram revealed Tetralogy of Fallot (TOF), with PS, with PDA and a septum secundum Atrial Septal Defect (ASD). The diagnosis of

Fig. 1 The blueberry muffin rash involving the face and neck in the child

Fig. 2 Buphthalmos in the baby boy

Indian J Pediatr Table 1 Comparison of findings seen in the three cases Case 1 IUGR Birth weight Antenatal history Blueberry muffin rash Microcephaly Thrombocytopenia Cardiac involvement Ophthalmological involvement Bony involvement Hepatitis Deafness Mental retardation Serological confirmation
a

Case 2 + 1.085 kg Uneventful + + + + NKa NKa +

Case 3 + 1.64 kg Uneventful + + + + + NKa NKa +

+ 1.145 kg Uneventful + + + + + + +

Fig. 3 Radiograph showing metaphyseal translucencies in the long bones (femur)

CRS was made. The skeletal survey showed a moth eaten appearance in the long bones (classic metaphyseal translucencies) (Fig. 3). The baby was discharged on day seven. However, he died at 1.5 mo due to heart disease. The salient features of these three patients are shown in Table 1. Rubella is a communicable exanthematous disease caused by Rubella virus. Any injury affecting the fetus in the first trimester (the phase of organogenesis) results in congenital organ defects. The manifestations of CRS include transient manifestations like hepatitis, thrombocytopenia, and blueberry muffin rash. Permanent manifestations include deafness, eye lesions, cardiac lesions, microcephaly, and mental retardation. The European Regional Committee of World Health Organization had adopted the goals of Elimination of CRS by 2000AD in the Health for All programs [1], which still remains a distant dream. We fear

Not Known

that cases of CRS may be increasing, although more data is required to conclusively prove this. Our work highlights peculiar presenting features of a patient with CRS, like blueberry muffin rash and buphthalmos, which led to the work up of these patients and established the diagnosis of CRS in all three.

Reference
1. World Health Organization. Expanded pro-gram on immunization. European conference on immunization policies. Wkly Epid Rec. 1985;60:16572.