A Rare Case of Neuroblastoma Presenting with Skin Findings

Neuroblastoma is the most common extra-cranial solid tumor in infants and children, Neuroblastoma tends to behave quite differently in infants as compared to children over 12-18 months.

We present a rare case of neuroblastoma presenting with skin rash as a preliminary finding.

Case:

A 39-day-old male patient with no medical history was admitted to our hospital with yellow bullous rash that started on the face and spread throughout the body in 15 days. The patient was born at term by caesarean section. His neurologic development is appropriate for his age. There is no family history and his parents are not related. On physical examination, he had yellow bullous rash all around his body , inspiratory stridor was auscultated and respiratory distress was seen.

The patient was consulted to dermatology clinic for his bullous rash and skin biopsy was performed. Bullous pemfigoid was detected pathologically, which is rare condition in infancy. Because the patient had inspiratory stridor and respiratory distress chest X-Ray was performed and reported normal. For further evaluation the patient was consulted to pediatric pulmonary specialist and with their suggestion thorax CT was performed. A solid mass that was suspected to be a neuroblastoma was found. So we performed abdominal MRI, and taken tru cut biopsy and determined neuroblastoma. İmmunoglobulin levels and lymphocyte subgroups were analyzed and found normal due to suspicion of immune deficiency.

Conclusion: Rashes are extremely common in infancy. Most of them are innocent and transient. However, serious infectious, congenital skin diseases and sometimes malignant tumors should be kept in mind when dealing with a rash in infancy.

We recommend that every infant with a skin rash and respiratory distress should be investigated for a infancy neuroblastoma.

The clinician should keep in mind that skin rash may be the first clinical finding of neuroblastoma.