Published online Nov 26, 2019. doi: 10.12998/wjcc.v7.i22.3800
Peer-review started: June 26, 2019
First decision: September 9, 2019
Revised: September 25, 2019
Accepted: October 5, 2019
Article in press: October 5, 2019
Published online: November 26, 2019
Processing time: 155 Days and 11.3 Hours
New-onset systemic lupus erythematosus (SLE) during pregnancy and in the postpartum period is rare, especially when complicated with pre-eclampsia, which is difficult to diagnose accurately. Here, we report a patient with new-onset SLE and antiphospholipid syndrome during pregnancy, which presented as pre-eclampsia at admission.
A 28-year-old primigravid woman was admitted to our hospital in the 27th wk of gestation with the primary diagnosis of severe pre-eclampsia. Although spasmolysis and antihypertensive therapy were administered since admission, the 24-h proteinuria of the 2nd day after admission reached 10311.0 mg. In the 47th h of admission, immunologic examinations revealed increased levels of anti-double stranded DNA antibody, anti-nuclear antibody, anti-cardiolipin antibody, anti-Sjögren’s syndrome-related antigen A antibody and anti-nucleosome antibody and decreased levels of complement C3 and C4. One hour later, ultrasonography of the lower limbs showed thrombus of the bilateral popliteal veins. The diagnosis of SLE and antiphospholipid syndrome was indicated. In the 54th h, the patient manifested with convulsion, dyspnea and blurred vision. Ten hours later, intrauterine death was revealed by ultrasonography. Emergent surgery consisting of inferior vena cava filter implantation and subsequent cesarean section was performed. Following glucocorticoid and anticoagulation therapy after delivery, the patient had an optimal response with improvements in symptoms and immunological markers.
Obstetricians should be aware of the symptoms and immunological examination results to distinguish pre-eclampsia and underlying SLE for optimal pregnancy outcomes.
Core tip: New-onset systemic lupus erythematosus during pregnancy and in the postpartum period is rare, especially when complicated with pre-eclampsia, which is difficult to diagnose accurately. We report a patient with new-onset systemic lupus erythematosus and antiphospholipid syndrome during pregnancy, which presented as pre-eclampsia at admission, and intrauterine death was revealed by ultrasonography. The patient showed improvements in symptoms and immunological markers after emergent surgery and drug therapy. Obstetricians should be aware of the symptoms and immunological examination results to distinguish pre-eclampsia and underlying systemic lupus erythematosus for optimal pregnancy outcomes.