title: Neonatal vesiculopustular eruption associated with transient myeloproliferative disorder: report of four cases.
abstract: BACKGROUND
  Transient myeloproliferative disorder (TMD) affects up to 10% of patients with Down syndrome (DS). A small proportion of newborns are asymptomatic and only manifest circulating blast cells, with or without leukocytosis, while others present with hepatomegaly, splenomegaly, serous effusions, and liver fibrosis. Few cases in the literature also have skin manifestations, described as crusted, erythematous, vesiculopustular eruptions occurring mainly on the face, with spreading to the trunk and extremities.
  
  
  METHODS
  Four patients with DS and TMD were studied due to the presence of cutaneous eruptions. Systemic involvement, work-up, and follow-up were documented for each patient. Our results were compared with the previously reported cases.
  
  
  RESULTS
  All patients were males, with ages ranging from 1 to 20 days at the time of diagnosis. In three patients, the eruption was papulopustular, and two of them also had vesicles. In one patient, lesions resembled bullous impetigo. In all, the lesions involved the face, followed by the extremities in three and the trunk in two patients. Pathergy phenomena was present in one patient. Hepatomegaly and a leukemoid reaction were present in all patients. Bone marrow showed an M7 immunophenotype in three patients and normal cellularity in one. Follow-up ranged from 2 to 11 months, during which the patients were healthy.
  
  
  CONCLUSIONS
  Recognition of the cutaneous eruptions associated with TMD in neonate patients with DS may lead to early diagnosis and avoidance of unnecessary chemotherapy. However, because leukemia may develop later, careful follow-up is mandatory in all cases.
authors.affiliation: Department of Dermatology, National Institute of Pediatrics, Mexico City, Mexico Department of Pathology, National Institute of Pediatrics, Mexico City, Mexico.
authors.forename: Veronica
authors.initials: V
authors.lastname: Narvaez-Rosales
authors.forename: Marimar Saez
authors.initials: MS
authors.lastname: de-Ocariz
authors.forename: Daniel
authors.initials: D
authors.lastname: Carrasco-Daza
authors.forename: Brenda
authors.initials: B
authors.lastname: Ramirez-Davila
authors.forename: Luz
authors.initials: L
authors.lastname: Orozco-Covarrubias
authors.forename: Carola
authors.initials: C
authors.lastname: Duran-McKinster
authors.forename: Carolina
authors.initials: C
authors.lastname: Palacios-Lopez
mesh_terms: D004314:Down Syndrome / Q000150:complications / Q000473:pathology*; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000209:etiology / Q000473:pathology*; D008297:Male; D009196:Myeloproliferative Disorders / Q000150:complications / Q000473:pathology*; D012867:Skin / Q000473:pathology*; D012872:Skin Diseases, Vesiculobullous / Q000209:etiology / Q000473:pathology*