APLASIA-CUTIS-CONGENITA, ELEVATED ALPHA-FETOPROTEIN, AND A DISTINCT AMNIOTIC-FLUID ACETYLCHOLINESTERASE ELECTROPHORETIC BAND

Aplasia cutis congenita affecting the elbows, knees, hips, and gluteal area was observed in a female newborn, product of a twin pregnancy. O ne of the twins was a fetus papyraceous detected at 15 weeks of pregna ncy. During the course of the pregnancy, maternal thrombocytosis was d iagnosed and treated with aspirin. Alpha-fetoprotein was elevated in m aternal serum and amniotic fluid, and a distinct electrophoretic acety lcholinesterase band was seen in amniotic fluid. These findings are in agreement with the classification of aplasia cutis congenita as propo sed by Frieden et al in which type V is related to the presence of a f etus papyraceous or placental infarcts. The findings in the present ca se may be explained by the effect of the dead twin on the surviving fe tus and the extensive denuded skin areas. Long-term follow-up of the i nfant showed that the lesions were cured, most of them with minimal sc ars. Increased risk for aplasia cutis congenita should be considered w hen elevated maternal and amniotic fluid alpha-fetoprotein and a disti nct electrophoretic band of acetylcholinesterase are found. Especially when one of the twins is dead.