Congenital Rubella Syndrome with Rubella Virus-associated Generalized Brownish Macules, Indurated Erythemas, Papules, and Pigmentation

Background We examined an infant with congenital rubella syndrome (CRS). The purpose of this report is to describe the skin manifestations in this patient and to prove that they were associated with rubella virus. Observations A 7-month-old boy presented with generalized brownish macules, indurated erythemas, papules, and pigmentation. They first appeared at around 3 months of age. His mother had contracted rubella during the 14th gestational week. At the time of examination, rubella-specific IgM antibody was positive in both serum and cerebrospinal fluid of the baby. A physical exam had revealed deafness, mental and physical retardation, interstitial pneumonitis, and hepatosplenomegaly. A skin biopsy specimen showed a dense infiltration mainly of lymphocytes, with B cells predominant in the deep dermis. Electron microscopically abundant tubuloreticular structures were observed in capillary endothelial cells, lymphocytes, and dermal fibroblasts. Polymerase chain reaction (PCR) analysis suggested that rubella virus RNA was present in the patient's skin specimen, cerebrospinal fluid, and total blood. Conclusions The cutaneous manifestations of our patient were extraordinary and informative. These prominent skin lesions should be recognized as cutaneous markers of CRS.