The correct answer is E. Heart block often develops after birth.
Heart block often develops after birth. This baby has neonatal lupus erythematosus (NLE). Heart block is almost always present by birth, but on rare occasions has developed after birth.1
In babies who have NLE, the SCLE-like lesions are histologically identical to those of SCLE in adults, and there is a strong association with anti-SSA/Ro antibodies. Indeed, almost 100% of babies with NLE have anti-SSA/Ro antibodies, and there are also reports of the presence of anti-U1RNP autoantibodies. Unlike SCLE in adults, lesions have a predilection for the face, especially the periorbital region and scalp. Neonatal lupus skin lesions typically resolve without scarring, although dyspigmentation may persist for many months, and some children have residual telangiectasias.1
1. Bolognia JL, Schaffer JV, Cerroni L, Callen JP. Dermatology Volume 2. Edinburgh Elsevier; 2018.