Neonatal lupus erythematosus (NLE) is characterized by cutaneous lupus, isolated congenital heart block (CHB), and a variety of systemic and hematologic abnormalities. The incidence of NLE is about 5–10% in mothers with systemic lupus erythematosus (SLE) [1]. Neonatal cutaneous lupus is a benign and self-limiting condition when it presents in isolation. The presence of anti-Ro autoantibodies in the affected infant’s serum correlates with disease activity in the skin. The disease activity generally resolves by about the age of 6 months as the antibody titer decreases [2]. The mean time of detection of the skin rash ranges from birth to 20 weeks postpartum with a mean age at detection of 6 weeks. The rash is often exacerbated after exposure to UV light. In previous reports, only a minority (16–23%) of infants were found to have the rash at birth [2,3]. We report here a female baby who was born to an SLE mother with positive anti-Ro and anti-La; the baby already had an extensive skin rash at birth, suggesting that sun exposure was not a requirement for these skin lesions. A woman aged 32 years, gravida 3, para 2, gave birth to a female baby with an extensive skin rash. The delivery was by cesarean section at 39 +6 weeks of pregnancy because of breech presentation. The patient had been in good health until she was aged 31 years when, 3 months before this pregnancy, she developed a malar rash. An evaluation at a hospital led to the diagnosis of SLE. Low-dose prednisolone was administered but was discontinued by the patient herself after the pregnancy was diagnosed. Her obstetric history consisted of two normal spontaneous vaginal deliveries. Both female babies were normal. She had no other medical or surgical history, and did not take any medications after the pregnancy was detected. The whole course of the pregnancy was uneventful. There was no skin rash, arthralgia or myalgia during the pregnancy. An antenatal sonography at 20 weeks of pregnancy revealed no fetal cardiac arrhythmia. Her prenatal screening test for antibodies to rubella was positive and tests for syphilis and hepatitis B surface antigen were negative. Her laboratory tests at 39 +6 weeks of pregnancy showed positivity for antinuclear antibodies (ANA) (1/2,560, speckled pattern), anti-Ro (1/575) and anti-La (1/721), but were negative for anti-ribonucleoprotein (RNP) and anti-Sm. The female infant had a birth weight of 2,660 g, an Apgar score of 8 at 1 minute and 9 at 5 minutes. Meconium staining and an extensive skin rash were noted at birth. Widespread geographic erythematous annular and scaly plaques occurred over the face, scalp, trunk and legs, and were most marked on the face. The spectacle-like erythemas around her eyes gave a “mask” or “owl’s eye”-like appearance (Figure 1). Some petechiae were displayed in her inguinal areas. A geographic erythematous plaque was seen over the left upper abdomen (Figure 2). There was no involvement of the conjunctiva or the vaginal mucosae. A 12-lead electrocardiogram showed a normal sinus rhythm and