Fetomaternal haemorrhage and prenatal intracranial bleeding: two more causes of blueberry muffin baby

Abstract

Blueberry muffin lesions are associated with prenatal infections, severe and chronic anemia and neoplastic infiltrative diseases. In the first two instances they represent postnatal re-expression of cutaneous haematopoiesis, in the latter they are cutaneous localizations of a neoplastic disease. Chronic prenatal anaemia leading to blueberry muffin lesions in the neonate has been reported in association with severe haemolytic anaemia such as congenital spherocytosis, Rhesus haemolytic disease and ABO incompatibility, or in anaemia caused by twin-to-twin transfusion. We present two more causes of prenatal anaemia leading to blueberry muffin lesions: chronic fetomaternal haemorrhage and severe intracranial bleeding.

Conclusion In any blueberry muffin baby with profound anaemia, chronic fetomaternal haemorrhage and severe internal bleeding should be included in the differential diagnosis. Skin biopsy must be performed to rule out neoplastic infiltrative diseases.