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Query: UMLS:C0024141 (systemic lupus erythematosus)
 44,322 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We describe a 31-year-old patient with missed abortion, thrombocytopenia, and clinical, laboratory, and radiologic evidence of hepatic infarction. On evaluation, she was found to have the lupus anticoagulant. The association between enhanced thrombosis and the lupus anticoagulant is discussed, and previously reported thrombotic complications are described. The etiology, clinical course, and radiologic features of liver infarction are summarized, and the importance of recognizing and treating this form of hypercoagulability is stressed. To our knowledge, this is the first description of liver infarction associated with the lupus anticoagulant.
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PMID:Hepatic infarction in a patient with the lupus anticoagulant. 249 3

This retrospective study of 31 patients with systemic lupus erythematosus during 38 pregnancies shows a spontaneous or missed abortion rate of 7.9%, elective abortion rate of 10.5%, and a perinatal mortality rate of 12.9%. There was one maternal death 5 weeks post partum. If the onset of systemic lupus erythematosus during pregnancy included nephritis or significant thrombocytopenia, the mothers were acutely ill. All of the perinatal mortality occurred in these patients. Management of systemic lupus erythematosus during pregnancy need not differ from that in the nonpregnant state. However, immunosuppressive therapy should not be diminished or discontinued during pregnancy. Clinical parameters, renal function studies, and hematologic information were far more useful than immunologic laboratory data in assessing the course of systemic lupus erythematosus during pregnancy and indicating alterations in treatment. Antepartum fetal surveillance is advised. The timing of and route of delivery must be individualized, and systemic lupus erythematosus in and of itself is not an indication for delivery by cesarean section.
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PMID:Pregnancy in patients with systemic lupus erythematosus. 683 78

The placental lesions generally attributed to the effects of systemic lupus erythematosus (SLE) on the decidual and placental villi include decidual vasculopathy, placental infarcts and possibly intrauterine growth retardation. The maternal decidual vessels in SLE show a lesion termed "acute atherosis" which is histologically similar to acute vascular rejection in a transplanted kidney. These changes can be so extensive as to result in complete vascular occlusion, decreased placental perfusion and resultant placental villous infarction. In currettings from products of conception in the first trimester, acute atherosis is a rare finding. We describe striking decidual vasculopathy and extensive villous infarction in a case of a first trimester missed abortion in a patient with SLE who had anticardiolipin antibodies (ACL), both immunoglobulin (IgG) and IgM, and lupus anticoagulant (LA) in her serum. To the best of our knowledge, this is the first report of acute atherosis and villous infarction in a first trimester placenta in association with SLE and/or ACL and LA. Pathologists should be aware of these changes and alert clinicians to the possibility of SLE or antiphospholipid and/or anticardiolipin antibodies.
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PMID:Placental changes in a first trimester missed abortion in maternal systemic lupus erythematosus with antiphospholipid syndrome; a case report and review of the literature. 861 65

A 37-year-old woman underwent an emergency operation at our hospital because of severe abdominal pain and ileus. Most of her small intestine and ascending colon were observed to have become necrotic due to occlusion of her superior mesenteric artery (SMA). Pathological findings of the resected intestine revealed that her SMA was completely thrombosed 2 cm distal from its origin with smooth muscle proliferation. Post-surgical blood analysis of her pre-operative serum was positive for lupus anticoagulant and antinuclear antibodies. She noticed vaginal bleeding due to missed abortion on the 31st day after the operation. We diagnosed her acute abdominal pain to be that of antiphospholipid syndrome associated with her pregnancy.
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PMID:Antiphospholipid syndrome complicated by thrombosis of the superior mesenteric artery, co-existence of smooth muscle hyperplasia. 924 May 7

Maternal serum inhibin A levels are increased on average in pregnancies affected by Down syndrome (DS). However, some reports have found increased serum levels in women with pre-eclamptic toxaemia as well. In the current study, maternal serum inhibin A was retrospectively measured in a series of 32 serum samples from pregnant women previously diagnosed as having either systemic lupus erythematosus (SLE) or primary antiphospholipid syndrome (APS). For comparison, normal medians were calculated from 57 unaffected control pregnancies together with a total of 854 samples tested at 13-19 weeks of gestation as part of the routine antenatal DS screening. All results were expressed in multiples of the gestation specific normal medians (MoM). A cubic regression formula was fitted, weighting for the number of women tested at each gestation. The median MoM value in the 16 cases of SLE and the 16 cases of primary APS is 0.60 (95% confidence interval 0.40-0.91) and 0.88 (95% confidence interval 0.66-1.17), respectively. For primary APS this was not statistically significant, whereas the SLE patients had a highly statistically significant reduction of serum inhibin A (p<0.002, Wilcoxon Rank sum Test, 2 tailed). Six pregnancies in the SLE group had a complicated obstetric outcome, i.e. missed abortion, placental abruption, exacerbation of the underlying disease which necessitated delivery, and severe postpartum haemorrhage. In 85% of this subgroup, serum inhibin A levels were below the normal 10th centile. The current data suggest that serum inhibin A is decreased on average in SLE patients. Those preliminary results might have various obstetric implications such as antenatal DS screening of SLE patients, identification of pregnant women at risk of developing SLE, who have presented for routine DS screening and for monitoring SLE patients throughout their pregnancy.
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PMID:Serum inhibin A levels in pregnant women with systemic lupus erythematosus or antiphospholipid syndrome. 1070 44

Cytokines act at all stages of pregnancy from implantation to parturition. This review examines their relevance in recurrent miscarriage. However, recurrent miscarriage may be due to an inherently abnormal embryo (e.g., chromosomal abberations) or maternal factors (e.g., uterine anomalies or antiphospholipid antibodies). In the former, cytokines are not causative, but may be part of the mechanism of abortion. In the antiphospholipid syndrome, cytokines such as TNFalpha and IL-6 may be responsible for the associated thrombosis. Hence, an appropriate cytokine milieu could be responsible for whether the antibodies are pathogenic or merely an epiphenomenon. Natural killer cells seem to have a key role in immunosurveillance of the invading trophoblast. However, if activated by TNFalpha, natural killer cells may induce apoptosis in the trophoblast possibly leading to miscarriage. This action is inhibited by TGFbeta. Early ultrasound scanning and embryoscopy have revealed structural anomalies in karyotypically normal embryos which have terminated in first trimester missed abortion. Teratogens such as cyclophosphamide cause fetal demise by excessive apoptosis. Excessive apoptosis may be mediated by TNFalpha, TGFbeta and other cytokines. GM-CSF has been reported to prevent teratogenesis in laboratory animals. Both immunomodulation and hormonal support (progesterone or hCG supplements) have been used to improve the live birth rate in recurrently aborting women. Each may modulate the balance between various cytokines. Although neither hormonal support or immunopotentiation have been proven to be beneficial, the results and the role of cytokines themselves can only be assessed in trials of karyotypically normal embryos.
Lupus 2004
PMID:Cytokines in recurrent miscarriage. 1548 91

Systemic lupus erythematosus (SLE) is a chronic inflammatory disease of unknown cause. In this study, we report a case of SLE that was presented with persistent vomiting and liver involvement. To our knowledge, this is the first description of a patient with hepatic necrosis as the initial presentation of SLE in a previously healthy woman without any significant past medical history. In the literature, we found few cases of SLE with liver necrosis. In addition, all the cases found had a past medical history of a missed abortion or other complications of the disease. Therefore, if a young woman presents hepatic necrosis with a background of a previously missed abortion, it is better to perform anti-nuclear antibody (ANA) and anticardiolipin antibody tests as a preventive method for early diagnosis and early treatment.
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PMID:Hepatic necrosis: a main presentation of systemic lupus erythematosus in a previously healthy woman. 2217 71