The majority of cases of NLE show vacuolar alteration at the dermoepidermal interface and adnexal structures. Some cases exhibit a superficial and deep perivascular and periadnexal lymphocytic infiltrate without epidermal alteration, and rare cases may have eosinophils in the infiltrate.

Neonatal lupus erythematosus (NLE) is an autoimmune disease whose major findings are skin lesions and congenital heart block. Affected infants have maternal, transplacentally acquired, autoantibodies to Ro/SSA, La/SSB, or U1-RNP antigens. Anti-Ro/SSA is the predominant autoantibody, present in about 95% of cases. Mothers of babies with NLE may be asymptomatic initially or may have Sjögren syndrome, lupus erythematosus, overlap syndrome or, uncommonly, leukocytoclastic vasculitis. When evaluating a young woman with a cutaneous leucocytoclastic vasculitis, dermatologists should be aware of the possible presence of antibodies related to NLE. If any patient suffering a disorder related to NLE becomes pregnant, testing for autoantibodies and close obstetric prenatal care with fetal echocardiogram is necessary. In cases of fetal bradycardia, treatment with dexamethasone or betamethasone should be considered, as these drugs are accessible to the fetal circulation.

Patients with orthotopic heart transplantation may have a variety of arrhythmias. There are reports of successful radiofrequency catheter ablation of some of them. Two months after orthotopic cardiac transplantation by bicaval anastomosis, a 49-year-old man developed episodes of tachycardia. The patient developed with dyspnoea and hypotension during typical atrioventricular nodal reentrant tachycardia (AVNRT) revealed by electrocardiogram. During programmed atrial stimulation with progressively increasing prematurity, dual auriculoventricular nodal physiology was observed and AVNRT was induced. This tachycardia was successfully eliminated without complications by radiofrequency catheter ablation of the slow pathway. The patient remained asymptomatic at 4-month follow-up.

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