Neonatal lupus erythematosus: case report and review of the literature

Neonatal lupus erythematosus (NLE) is a disease of the first few months of infancy. It is caused by anti-SSA and anti-SSB antibodies, which are products of maternal autoimmune disorders (SLE, Sj?gren, rheumatoid arthritis) and can be passively transported across the placenta. The prevalence of NLE is low. The major clinical findings are cutaneous (typical annular erythematous plaques), cardiac, hepatic and hematologic alterations. Its most severe consequence is third-degree heart block, which is irreversible, requires pacemaker-implantation and responsible for the 20-30% mortality rate. Symptoms usually resolve spontaneously at age of 6-9 months in association with disappearance of maternal antibodies from the infant's serum. In our case the typical cutaneous manifestations covered virtually the whole body, were present at birth, however, no conduction defects developed. The fact that the mother's sickness was not known at birth made it difficult to establish the diagnosis. The significant thrombocytopaenia, progressive skin-changes and the elevated liver function tests necessitated systemic steroid treatment.     

Adult discoid lupus erythematosus

BACKGROUND: Discoid lupus erythematosus is a particular form of systemic lupus in which manifestations are confined to the skin. AIM: Our purpose was to evaluate the epidemiology trends, presenting clinical manifestations, therapeutic features and outcome of patients with discoid lupus erythematosus (DLE). METHODS: It's a retrospective study, done in the dermatology department of Habib Thameur Hospital over an 8 years period. We included only the cases of DLE confirmed by the histology and/or the direct immunofluorescence. RESULTS: We identified 26 patients mean aged 46.19 years. All of them were adults. The lesions were localized on the face for 25 patients, neck (7 patients), scalp (6) and hands (6). Eleven patients presented a generalized DLE. The mean period of follow-up was 3 years raging from 1 month to 20 years. After a 15 year evolution, 1 patient presented degeneration in squamous cell carcinoma of 2 lesions. CONCLUSION: Unfortunately, there is still in our country a long delay before the first consultation, which, added to an absence of adequate photoprotection, can obscure the prognosis of DLE.     

Systemic lupus erythematosus and pregnancy

The authors report on the successful outcome of pregnancy of a young woman with systemic lupus erythematosus. Her disease presented with severe renal involvement. The delivery was followed by lasting, complete remission. Even at the time of the report both the mother and her child are in a good health. On the occasion of this case-history the authors attempts, to summarize the present knowledge of pregnancy in systemic lupus erythematosus.     

Systemic lupus erythematosus and pregnancy

Systemic Lupus Erythematosus (SLE) is a disease primarily targeting fertile women. The odds of spontaneous miscarriage, preeclampsia, intrauterine growth restriction is higher in pregnant women with SLE as well as there are increased risks of preterm delivery and perinatal fetal death. The occurrence of spontaneous abortion is closely related to the presence of antiphospholipid antibodies. The disease on its own is not a contraindication of pregnancy but at least a six-month remission is suggested prior conception. The physiological changes in the course of pregnancy might have close resemblance to the symptoms of lupus, therefore these changes should be differentiated from symptoms caused by lupus. For mothers suffering from SLE, regular visits not only to their obstetricians but also to a rheumatologist are also recommended in order to allow at proper time recognition of potential complications and their appropriate treatment. Thorough check of the maternal disease is of high importance not only during but also prior to and following pregnancy. An overview is given of the opportunities of recent diagnosis and opportunities of therapeutic approaches including biological as well as stem cell treatments. The antithrombotics treatment increases the chance of survival and healthy child birth in the case of pregnant women suffering from antiphospholipid syndrome. Although occurring rarely, neonatal SLE has significantly higher morbidity and mortality compared to healthy births. Recent studies show positive results in the case of prophylactic treatment of neonatal lupus. Prenatal care is recommended to be conducted at an institute where the obstetrician is experienced in the possible complications of lupus and where consultation with a rheumatologist, and the treatment of neonates with low birth weight are ensured.     

妊娠与系统性红斑狼疮

系统性红斑狼疮是一种在年轻女性中好发的激素依赖性疾病.而一旦妊娠,将面临更多危险因素.然而,凭借早期的诊断、疾病状态的稳定及一个好的医疗团队对系统性红斑狼疮孕妇的密切监护,使系统性红斑狼疮患者妊娠的成功率不断提高.该文综述了妊娠与系统性红斑狼疮的关系、系统性红斑狼疮患者妊娠管理及治疗进展.     

Survival in systemic lupus erythematosus

The prevalence of SLE has increased throughout the world, due in part to the recognition of milder forms. Significant renal disease is now less common but late cardiovascular disease is being reported more often. The latter was previously attributed to steroid therapy, but we believe that the thrombotic tendency associated with antiphospholipid antibodies provides a significant contribution. Infection still ranks high in the mortality statistics in SLE, despite the move to more conservative treatment.