Image in medicine
Harlequin phenomenon in a newborn
Fenómeno de arlequín en recién nacida
Ana Román Fernández
, Leonor Bardallo Cruzado, Jessica Gómez Ávila, Susana León Carretero
Corresponding author
Servicio de Neonatología, Hospital Universitario Virgen Macarena, Sevilla, Spain
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On the third day of life, she presented with well-defined skin changes, with one side of the body plethoric and the other pale (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). They became self-limiting after 5 min and were repeated hours later on the contralateral side of the body, with no other symptoms (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">This phenomenon called harlequin syndrome is related to sympathetic autonomic dysfunction due to hypothalamic functional immaturity, producing capillary vasodilatation and vasoconstriction. The idiopathic cause is the most common and may occur in healthy newborns.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Other possible causes include central nervous system involvement, such as hypoxia, meningitis, hypothalamic and brainstem lesions, and treatment with anaesthetics or prostaglandins. It usually occurs between the second and fifth day and resolves spontaneously, with several episodes occurring in a 24-h period. It should not be confused with harlequin ichthyosis, the most severe variant of congenital ichthyosis.</p><p id="par0020" class="elsevierStylePara elsevierViewall">After 8 days, the patient had tonic-clonic seizures, requiring several anticonvulsant drugs. Brain MRI showed white matter involvement, right caudate and bilateral ventricular haemorrhage. It later evolved into West syndrome. Therefore, this phenomenon may be an indication of a severe central nervous system disorder.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical considerations</span><p id="par0025" class="elsevierStylePara elsevierViewall">We, the authors of the manuscript, declare that we have obtained the informed consent of the patient’s parents for the use of images for teaching purposes or for the dissemination of scientific knowledge.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Funding</span><p id="par0030" class="elsevierStylePara elsevierViewall">No funding has been received for this work.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflict of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">None of the authors have any conflict of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Ethical considerations" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Funding" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflict of interest" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 933 "Ancho" => 681 "Tamanyo" => 94931 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 933 "Ancho" => 873 "Tamanyo" => 94405 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000016200000003/v2_202402160843/S2387020624000056/v2_202402160843/en/main.assets" "Apartado" => array:4 [ "identificador" => "51820" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in medicine" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000016200000003/v2_202402160843/S2387020624000056/v2_202402160843/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020624000056?idApp=UINPBA00004N" ]
