Cutis Marmorata Telangiectatica Congenita: Early Detection in Two Premature Infants

To the Editors: Cutis marmorata telangiectatica (CMTC) is a rare vascular anomaly characterized by lasting discoloration of the skin in a reticulate pattern. We report two cases of CMTC in premature infants. Patient 1 was a premature baby boy born at 31 weeks gestation and referred to the department of dermatology for skin examination. He was delivered by cesarean section due to placenta previa totalis. Apgar score was 7 at 1 minute and 8 at 5 minutes; birth weight was 1.59 kg. From the moment of birth, he had reticulated, blue-violet patches all over his body that did not disappear with changes in temperature (Fig. 1). He had no other systemic or dermatologic disorders. He did not have an extraordinary family history. His mother was 35 years old, with a gestational history of 1-0-5-1. During the midtrimester (20 weeks) she received oral medications for common cold symptoms for 2 days consisting of acetaminophen, piroxycamb-cyclodextrin, chlorpheniramine, and an intramuscular injection of amoxicillin. She was also treated with oral aspirin and dydrogesterone by her obstetrician for vaginal bleeding. The patient’s laboratory examinations, radiographs of the chest and skull, cranial CT, EKG, metabolic and chromosomal study, amino acid analysis, VDRL, and ANA were normal. Based on the histologic examination and clinical manifestations, he was diagnosed with CMTC and was observed, but alteration of the lesion was minimal. The patient was seen at a follow-up visit 4 months after discharge from the hospital, at which time there was some fading of the lesions, but they had not cleared completely. Patient 2 was a premature baby boy born at 33 weeks gestation and referred to the department of dermatology for skin examination. He was delivered by cesarean section due to pregnancy-induced hypertension. Apgar score was 7 at 1 minute, 8 at 5 minutes, and birth weight was 1.26 kg. From the moment of birth, he had reticulated, blue-violet patches all over his body that did not disappear with changes in temperature. He did not have any other systemic or dermatologic symptoms. His mother was 28 years old and her gestational history was 0-0-1-0. He had no extraordinary family history. Also, his mother did not have any medication history during pregnancy. Laboratory investigations including full blood count, VDRL, and ANA were negative or within normal limits. Based on clinical manifestations, he was diagnosed with CMTC and was observed, but alteration of his lesions was minimal. Three months after discharge, at his follow-up visit, there was only slight improvement in the lesions. In 1922, van Lohuizen (1) described a child with unusual skin lesions that resembled livedo reticularis, accompanied by telangiectases and superficial ulcerations. The patient’s clinical course was characterized by steady improvement in the appearance of the lesions over an 18-month period. Since then more than 100 cases of CMTC have been reported in the literature under various names, such as generalized congenital phlebectasis (2),