Acta Dermato-Venereologica 2018, No. 6 98-6CompleteContent | Page 21

QUIZ SECTION Scalp Hair Hypopigmentation in a Five-month-old Infant: A Quiz Sophie LEDUCQ 1,2 , Emmanuelle BLANCHARD 1,3,4 , Thierry PEREZ 1,5 and Annabel MARUANI 1,2 1 University of Tours, 2 Department of Dermatology, 3 IBiSA Electron Microscopy Facility, 4 INSERM U1259, and 5 Pediatric Intensive Care Unit, CHRU Tours, Avenue de la République, FR-37044 Tours Cedex 9, France. E-mail: [email protected] A 5-month-old male infant was examined for heterochromia of scalp hair that had occurred 3 months previously. He was born at 39 weeks’ gestation from a primigravida Chinese mother and a French father. From birth, he was admitted to a paediatric intensive care unit because of multiple congenital malformations (tetralogy of Fallot and oesophageal atresia) with no identified syndrome. His foetal karyotype was nor- mal, but no further genetic analyses were performed. His height was 58 cm and weight 5.330 kg. During hospitaliz a- tion, several bacterial and fungal infections occurred. The infant underwent surgical treatment of oesophageal atresia at age 4 months and received numerous drugs to treat cardiac insufficiency (spironolactone, propranolol, furosemide) and infections (amoxicillin, cefotaxime, gentamycin, cefazolin, tazocillin, fluconazole). Cutaneous examination was normal. There were no mu- cosal lesions. The infant had straight dark-brown hair of normal density. The hair featured 3 lighter-coloured bands (Fig. 1a) and the hair shafts were otherwise of normal diameter, with no fragile hair and no alopecia. Laboratory tests demonstrated normal complete blood count, albumin level was 42 g/l (normal >35 g/l) and liver tests gave nor- mal results. Values for vitamins and thyroid function were normal. However, the infant had experienced periods of protein deficiency. Hair samples were obtained for analysis by scanning electron microscopy (SEM), which revealed normal and homogeneous diameter of hair shafts (56 µm) with a well-preserved cuticular pattern. Moderate hair dysplasia with incomplete twisted hair (Fig. 1b), flattening and longitudinal fluting (Fig. 1c) were evidenced in both hypopigmented and normally pigmented areas. The infant died at age 9 months of Serratia marcescens respiratory tract infection. What is your diagnosis? See next page for answer. 618 Fig. 1. (a) Clinical image: 3 bands of lighter-coloured scalp hair in a 5-month-old male. Scanning electron microscopy at magnification (b) ×250 and (c) ×150 showing hair dysplasia (twisted hair and longitudinal fluting). (d) Body mass index curve showing 3 inflections related to the periods of lighter hair lines. doi: 10.2340/00015555-2928 Acta Derm Venereol 2018; 98: 618–619 This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2018 Acta Dermato-Venereologica.