Neonatal Migratory Polycyclic Erythema of Urticaria Associated with Alprostadil: A Case Report

Abstract

A full-term male neonate was diagnosed with complex heart disease. His diagnosis included Taussig-Bing anomaly, TGA, large subpulmonic VSD, large PDA, severe coarctation, and interrupted aortic arch. The patient was transferred to our institution, a super-tertiary care for probable management within 5 hours after birth. The 3.3 kg infant was delivered by cesarean section. Cyanosis was noted at birth. The hypoxemia and cyanosis did not improve after using an oxygen mask with bag (oxygen saturation 80%). Intubation with subsequent mechanical ventilation was initiated in this case. Ampicillin and cefotaxime were administered for possible early neonatal sepsis. An echocardiogram revealed dextro-Transposition of the great arteries (d-TGA), large subpulmonic VSD, left aortic arch, large PDA, hypoplastic aortic arch, severe coarctation, and interrupted aortic arch. Alprostadil was started within 3.5 hours after birth. Arterial switch operation (ASO) was planned. The patient’s intravenous medications included dopamine, dobutamine, fentanyl, furosemide, calcium gluconate, sodium bicarbonate, potassium chloride, ampicillin, cefotaxime, and heparin. Abstract The aim of this study was to report a case of neonatal migratory polycyclic erythema of urticaria associated with alprostadil. A full-term male neonate with complex heart disease was diagnosed. The patient had a Taussig-Bing anomaly, transposition of the great arteries (TGA), large subpulmonic ventricular septal defect (VSD), large patent ductus arteriosus (PDA), severe coarctation and interrupted aortic arch. The patient developed an adverse drug reaction during alprostadil infusion. Following the reaction, alprostadil was administered at sequentially reduced doses, and the patient eventually became tolerant of alprostadil. The patient successfully continued therapy with no further reactions or recurrences. No adverse drug reactions developed during infusion until the patient was discharged from the hospital and was transferred to a tertiary care hospital for cardiothoracic surgery.