An unusual migratory polycyclic eruption after administration of prostaglandin E in a neonate

Alprostadil is a prostaglandin E1 analogue (PGE1 α-cyclodextrin clathrate) used in neonates to maintain a patent ductus arteriosus in cases of ductal-dependent congenital heart disease (CHD).1 PGE1 is critical in sustaining oxygen saturation in these patients while awaiting surgical repair or cardiac transplant. Despite being reasonably well tolerated, a review of 62 neonates with CHD treated with PGE1 suggested a range of adverse events, most commonly including central nervous system events (16%), respiratory depression (12%), and cardiovascular complications (18%).2 Cutaneous flushing and peripheral edema are well-recognized side effects of PGE1 infusion,2 although there is a paucity of data with regard to cutaneous adverse events. A search of the literature found 4 other cutaneous reactions reported, including harlequin color change, urticaria, and subcutaneous fat necrosis of the newborn.3, 4, 5 We present a case of an extensive and striking polycyclic eruption associated with PGE1 administration in a 2-day-old neonate and highlight the importance of recognizing this entity to avoid delay in diagnosis and unnecessary interventions.