2 Miyako K, Kinjo S, Kohno H. Vitamin D deficiency rickets caused by improper lifestyle in Japanese children. Pediatr. Int. 2005; 47: 142–6. 3 Kamen D, Aranow C. Vitamin D in systemic lupus erythematosus. Curr. Opin. Rheumatol. 2008; 20: 532–7. 4 Cutolo M, Otsa K. Review: Vitamin D, immunity and lupus. Lupus 2008; 17: 6–10. 5 Martin V, Lee LA, Askanase AD, Katholi M, Buyon JP. Long-term followup of children with neonatal lupus and their unaffected sib- lings. Arthritis Rheum. 2002; 46: 2377–83. 6 Lee LA. Transient autoimmunity related to maternal autoantibod- ies: Neonatal lupus. Autoimmun. Rev. 2005; 4: 207–13. 7 Muller K, Kriegbaum NJ, Baslund B, Sorensen OH, Thymann M, Bentzen K. Vitamin D3 metabolism in patients with rheumatic diseases: Low serum levels of 25-hydroxyvitamin D3 in patients with systemic lupus erythematosus. Clin. Rheumatol. 1995; 14: 397–400. 8 Kamen DL, Cooper GS, Bouali H, Shaftman SR, Hollis BW, Gilkeson GS. Vitamin D deficiency in systemic lupus erythemato- sus. Autoimmun. Rev. 2006; 5: 114–7. 9 Chen S, Sims GP, Chen XX, Gu YY, Lipsky PE. Modulatory effects of 1,25-dihydroxyvitamin D3 on human B cell differentia- tion. J. Immunol. 2007; 179: 1634–47. 10 Lemire JM, Ince A, Takashima M. 1,25-Dihydroxyvitamin D3 attenuates the expression of experimental murine lupus of MRL/l mice. Autoimmunity 1992; 12: 143–8. Elevated serum a-fetoprotein in a neonate with cutaneous infantile hemangioendothelioma Tai-Heng Chen, 1,3,5 Jan-You Lin, 4 Wu-Fu Chen, 6 Yue-Chiu Su 2 and San Nan Yang 1,5 Departments of 1 Pediatrics, and 2 Pathology, 3 Division of Pediatric Emergency, Department of Emergency, 4 Division of Pediatric Surgery, Department of Surgery, Kaohsiung Medical University Hospital, and 5 Graduate Institute of Medicine, Kaohsiung Medical University, and 6 Department of Neurosurgery, Chang Gung Memorial Hospital – Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan Key words a-fetoprotein, extrahepatic, hemangioendothelioma, neonatal. Infantile hemangioendotheliomas (IHE) are rare vascular tumors occurring mainly during infancy. 1 Approximately 85% of cases present before 6 months of age with predominant involvement of the liver, lung, calvarial bones or soft tissues of limbs. 2,3 In contrast to asymptomatic hemangiomas, which usually undergo spontane- ous regression within 1 year, IHE may be rapidly fatal due to complications of congestive heart failure, consumptive coagul- opathy, and respiratory compromise, resulting in a mortality rate as high as 90%. 1,3,4 Patients with hepatic IHE are occasionally found to have a high serum a-fetoprotein (AFP) level, 1,5 but have never been reported in solely cutaneous or soft-tissue-involving IHE. In addition, the recurrence of IHE is uncommon. 3 Here, we report a neonate with recurrent non-visceral IHE with persistently elevated serum AFP level, despite complete initial surgical exci- sion of the tumor. We suggest AFP level to be a useful clinical index for monitoring the bioactivity of extrahepatic IHE. Case Report A 14-day-old male neonate presented to our clinic with a 5 ¥ 4-cm 2 mass noted at his right medial thigh since birth. He was delivered vaginally at 39 weeks of gestation with a birth body- weight of 3038 g to nonconsanguineous parents. His antenatal ultrasonographic findings were negative and the perinatal period was uneventful. The mass appeared to be soft, flesh-colored with scattered violaceous stains, non-pulsatile and completely covered with skin (Fig. 1). There were no signs of hepatosplenomegaly or Correspondence: San Nan Yang, MD PhD, Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical Univer- sity, No. 100, Tzyou 1st Road, Sanmin District, Kaohsiung City 807, Taiwan. E-mail address: y520729@gmail.com All authors of this article indicated no potential conflicts of interest. Received 8 May 2009; revised 19 May 2010; accepted 2 August 2010. doi: 10.1111/j.1442-200X.2010.03242.x Fig. 1 The 5 ¥ 4-cm 2 protruding mass, located over the medial part of the right thigh. On gross examination, the mass appeared flesh- colored with several violaceous stains and was covered with intact skin without ulceration. 258 K Miyako et al. © 2011 The Authors Pediatrics International © 2011 Japan Pediatric Society