Case Presentation
Harlequin fetus or Harlequin is a very rare and most severe form of congenital ichthyosis characterized by a thick, heavily keratinized and scaly skin (1,2).
A 3.3kg term male neonate with Apgar scores of 8 and 9 at one and 5minutes respectively was delivered to a 25-year-old Eritrean woman by caesarean section. The baby was covered with thick yellowish to whitish scales, split by extensive some deep and others shallow fissures extending to the dermis. The scale covered almost the entire body. There was severe ectropion. There was scalp hair, the limbs were edematous and inflexible digits due to taut skins (Figure 1A, B and C). The pregnancy was uneventful. Both parents were paternal first-degree cousins. The baby was admitted to neonatal intensive care. In the first day, the baby was suckling well and was well hydrated. On the second day, the scales started to change in color (Figure 1D) and neonatal sepsis ensued. He was intravenous antibiotic, but he progressively deteriorated. The parents demanded, they wanted to take their baby home and they were discharged eventually against medical advice.