Volkan SOLMAZ, Dürdane AKSOY, Betül ÇEVİK, Semiha Gülsüm KURT, Elmas PEKDAŞ, Mehmet Can NACAR

Vasculitic Neuropathy in a Thırd Trimester Pregnant Patient with Systemic Lupus Erythematosus

Sistemik lupus eritematosus (SLE) daha çok doğurganlık çağındaki kadınlarda görülen inflamatuar otoimmun bir hastalıktır. 20 yaşındaki 35 haftalık gebe olan bayan hasta kliniğimize 20 gündür olan bacak ağrısı, bacaklarda kuvvetsizlik ve sol düşük ayak şikayetleri ile başvurdu. Özgeçmişinde ayda bir defa olan oral ülserler, zaman zaman eklem ağrıları ve gün ışığında belirginleşen malar rash vardı. yapılan EMG de duyusal ağırlıklı sensorimotor polinöropati tespit edildi ve hastaya SLE' ye bağlı vaskülitik nöropati tanısı konuldu. silik semptom ve bulguları olan SLE hastaları gebelik dönemindeki hastalığın sistemik alevlenmeleri neticisinde kötüleşebilir, dahası bu durum fetal ve maternal mortalitenin artmasına da neden olabilir. Dolayısıyla klinisyenler SLE li hastalarının gebelik dönemindeki alevlenmelere bağlı gelişebiliecek muhtemel komplikasyonlara karşı uyanık olmalılardır

Anahtar Kelimeler:

Sistemik lupus eritematosus, gebelik, periferal nöropati

Vasculitic Neuropathy in a Thırd Trimester Pregnant Patient with Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE) is an inflammatory, autoimmune disease that predominantly occurs in women of childbearing age. A 20-year-old, 35 week pregnant patient was admitted to our clinic with a 20 day history of leg pain, numbness in the feet, and left foot drop. On further examination, the patient reported oral ulcers once a month, occasional joint swelling, increasing malar rash under sunlight. Sensory-predominant sensorimotor polyneuropathy was detected on EMG, and a diagnosis of vasculitic neuropathy-related SLE was made. SLE patients with vague signs and symptoms may have new neurologic signs during pregnancy due to relapse of systemic disease. Moreover, there can be an increase in both fetal and maternal mortality. Therefore, clinicians should be wary of possible aforementioned complications during prenatal examinations of their pregnant patients with SLE.

Keywords:

Systemic lupus erythematosus, pregnancy, peripheral neuropathy,

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Josephine Patricia Dhar, MD and Robert J. Sokol, MD. Lupus and Pregnancy: complex Yet Manageable. Clin Med Res 2006;4:310–21.
Liem MD, Gzesh DJ, Flanders AE. MRI and angiographic diagnosis of lupus cerebral vasculitis. Neuroradiology 1996;38:134-6.
Ramos-Casals M, Nardi N, Lagrutta M, et al. Vasculitis in systemic lupus erythematosus: prevalence and clinical characteristics in 670 patients. Medicine 2006; 85:95-104.
Doria A, Iaccarino L, Arienti S, et al. Th2 immune devia- tion induced by pregnancy: the two faces of autoimmune rheumatic diseases. Reprod Toxicol 2006;22:234-41.
Sanna G, Bertolaccini ML, Cuadrado MJ, et al. Neuropsychiatric manifestations in systemic lupus ery- thematosus: prevalence and association with antiphos- pholipid antibodies. J Rheumatol 2003; 30:985-92.
Joseph FG, Lammie GA, Scolding NJ. CNS lupus: a study of 41 patients.Neurology 2007; 69:644-54.
Terekeci H, Top C. Pregnancy and Rheumatic Disease. Romatizma 2008; 23:143-50
Yasmeen S, Wilkins EE, Field NT, et al. SLE complicating pregnancy; Pregnancy outcomes in women with systemic lupus erythematosus. J Matern Fetal Med 2001; 10:91
Canti V, Castiglioni MT, Rosa S, et al. Pregnancy outcomes in patients with systemic autoimmunity. Autoimmunity 2012;45:169-75
Mintz G, Niz J, Gutierrez G, Garcia-Alonso A, Karchmer S. Prospective study of pregnancy in systemic lupus ery- thematosus. Results of a multidisciplinary approach. J Rheumatol1986;13:732-9.
Lockshin MD, Reinitz E, Druzin ML, Murrman M, Estes D. Lupus pregnancy. Case-control prospective study demon- strating absence of lupus exacerbation during or after pregnancy. Am J Med1984;77:893-8.
Urowitz MB, Gladman DD, Farewell VT, Stewart J,McDonald J. Lupus and pregnancy studies. Arthritis Rheum1993;36:1392-7.
Petri M. The Hopkins Lupus Pregnancy Center: ten key issues in management. Rheum Dis Clin North Am 2007;33:227–35
Gayed M, Gordon C. Pregnancy and rheumatic diseases. Rheumatology (Oxford) 2007;46:1634-40.
Day CJ, Lipkin GW, Savage CO. Lupus nephritis and pregnancy in the 21st century. Nephrol Dial Transplant 2009;24:344–7.
Smyth A, Oliveira GH, Lahr BD, et al. A systematic review and meta-analysis of pregnancy outcomes in patients with systemic lupus erythematosus and lupus nephritis. Clin J Am Soc Nephrol 2010;5:2060–8.
Chakravarty EF, Nelson L, Krishnan E. Obstetric hospital- izations in the United States for women with systemic lupus erythematosus and rheumatoid arthritis. Arthritis Rheum 2006;54:899–907.
Fine L G, Barnett E V. Danovitch G M, et al. Systemic lu- pus erythematosus in pregnancy. Ann Intern Med 1981; 94: 667-77.
Tandon A, Ibañez D, Gladman DD, Urowitz MB. The ef- fect of pregnancy on lupus nephritis. Arthritis Rheum 2004;50:3941-6.
Huynh C, Ho SL, Fong KY, Cheung RT, Mok CC, Lau CS . Peripheral neuropathy in systemic lupus erythematosus. J Clin Neurophysiol 1999;16:164–8.