Prostaglandin E1-induced urticaria with harlequin change in a neonate with transposition of great vessels: A case report

Prostaglandin E1 (PGE1) is an emergency drug used in neonates with critical congenital heart diseases (CHDs) to maintain the ductal patency. There are many adverse effects of this drug explained – cutaneous side effects being one of them, of which limited literature is available. In this case report, we describe a term neonate with critical CHD, started on PGE1 infusion to maintain ductal patency. Baby developed erythematous migratory annular rashes to harlequin colour change in a dose-dependent manner. The severity of rashes decreased, and there was a complete resolution with tapering down of drug doses to a minimum level to maintain a ductal patency. No antihistamines or steroids were administered for the treatment. The PGE1 should be tapered to a minimum dose to maintain the required saturation in case of severe cutaneous reaction and should not be stopped abruptly as it is a lifesaving drug in critical CHD.