Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 26, 2020; 8(24): 6396-6407
Published online Dec 26, 2020. doi: 10.12998/wjcc.v8.i24.6396
Immunotherapies application in active stage of systemic lupus erythematosus in pregnancy: A case report and review of literature
Zhi-Hui Xiong, Xiao-Song Cao, Hai-Lian Guan, Hui-Ling Zheng
Zhi-Hui Xiong, Hai-Lian Guan, Department of Obstetrics, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang Province, China
Xiao-Song Cao, Department of Medical Clinic, Lanxi No. 5 Middle School, Lanxi 321100, Zhejiang Province, China
Hui-Ling Zheng, Department of Obstetrics, The Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine, Hangzhou 310005, Zhejiang Province, China
Author contributions: Xiong ZH and Zheng HL carried out the studies, participated in data collection, and drafted the manuscript; Cao XS and Guan HL helped draft the manuscript; All authors read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: Hui-Ling Zheng, Department of Obstetrics, The Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine, No. 318 Chaowang Road, Gongshu District, Hangzhou 310005, Zhejiang Province, China. 147406773@qq.com
Received: July 21, 2020
Peer-review started: July 21, 2020
First decision: August 7, 2020
Revised: September 27, 2020
Accepted: October 27, 2020
Article in press: October 27, 2020
Published online: December 26, 2020
Abstract
BACKGROUND

Pregnancy in the setting of systemic lupus erythematosus can worsen the condition from the stable to active stage, with quality of life and fertility desire being particular concerns. Pregnancy in the active stage of systemic lupus erythematosus (ASLE), although rare and complicated to manage, can be treated favorably with immunotherapies ifs used properly. Here we report such a success case.

CASE SUMMARY

A 31-year-old primigravida patient, diagnosed with SLE seven years ago, was induced ASLE after a cold at 21 + weeks. The patient’s vital signs on presentation were normal. Her laboratory exam was remarkable for significant proteinuria, liver and renal dysfunction, and low C3 and C4 levels. Infectious work-up was negative. The patient was diagnosed with ASLE. She was given immunosuppressive agents (methylprednisolone, gamma globulin and azathioprine etc.) and plasma adsorption therapy, monitoring blood pressure every 8 h, fetal heart rate twice a day, and liver and renal function at least twice a week. Successful maternal and fetal outcomes are presented here.

CONCLUSION

Child-bearing in ASLE has become more promising, even for this difficult case of ASLE with multiple organ damage. Thorough antepartum counseling, cautious maternal-fetal monitoring, and multi-organ function monitoring by multidisciplinary specialties are keys to favorable pregnancy outcomes.

Keywords: Pregnant women, Systemic lupus erythematosus, Immunotherapies, Case report, Active stage of systemic lupus erythematosus, Literature review

Core Tip: For systemic lupus erythematosus (SLE) patients who were stable prior to pregnancy, a considerable proportion of them will have varying degrees of disease activity after pregnancy. Therefore, immunotherapy during pregnancy is an essential tool to maintain stable condition. However, many treatments, especially immunotherapies, have some adverse reactions, so the use of this therapy during pregnancy should be done cautiously. This paper presents a case of pregnancy complicated with active stage (ASLE), expounds the importance of immunotherapy in the control of ASLE, and summarizes the traditional and emerging immunotherapies for ASLE in order to provide some guidance for the clinical use of immunotherapies in pregnancy.