Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 26, 2019; 7(22): 3800-3806
Published online Nov 26, 2019. doi: 10.12998/wjcc.v7.i22.3800
Pre-eclampsia with new-onset systemic lupus erythematosus during pregnancy: A case report
Peng-Zhu Huang, Pei-Yang Du, Cha Han, Jun Xia, Chen Wang, Jie Li, Feng-Xia Xue
Peng-Zhu Huang, Pei-Yang Du, Cha Han, Jun Xia, Chen Wang, Jie Li, Feng-Xia Xue, Department of Obstetrics and Gynecology, Tianjin Medical University General Hospital, Tianjin 300052, China
Author contributions: Huang PZ drafted the table and manuscript; Du PY searched the relevant literature and collected the data; Han C contributed to the design and revision of this study; Xia J edited and contributed to manuscript drafting; Wang C and Li J were the patient’s obstetricians and reviewed the literature; Xue FX revised the final manuscript.
Supported by the Natural Science Foundation of Tianjin Municipal Science and Technology Commission, No. 16JCYBJC26400
Informed consent statement: Written informed consent was obtained from the patient for publication of this report.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Feng-Xia Xue, MD, PhD, Director, Professor, Department of Obstetrics and Gynecology, Tianjin Medical University General Hospital, 154 Anshan Road, He Ping District, Tianjin 300052, China. fengxiaxue1962@gmail.com
Telephone: +86-22-60363769 Fax: +86-22-27813550
Received: June 24, 2019
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
Abstract
BACKGROUND

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.

CASE SUMMARY

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.

CONCLUSION

Obstetricians should be aware of the symptoms and immunological examination results to distinguish pre-eclampsia and underlying SLE for optimal pregnancy outcomes.

Keywords: Systemic lupus erythematosus; Pre-eclampsia; Pregnancy; Case report

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.