Systemic lupus erythematosus in pregnancy; a rare complication at Federal Medical Centre, Yenagoa: a case report.
Meme FC1*, Igbafe AA1, Aigere ESO1, Njoku C1, Zakaa Z1, Mbah MK1, Ohaeri OS1, Okpara LA1
1Department of Obstetrics and Gynaecology, Federal Medical Centre, Yenagoa, Bayelsa State, Nigeria.
*Correspondence: Dr. Meme Franklin Chukwudi; +234 803 435 2914; firstname.lastname@example.org
Download full article in pdf format
Background: Systemic lupus erythematosus (SLE) is an autoimmune, multi-systemic disease, resulting in abnormal immune response. It predominantly affects women of childbearing age. The disease may not be uncommon among black women especially Nigerians contrary to previous assumptions. A high index of suspicion is, therefore, needed especially during pregnancy in women presenting with symptoms and signs suggestive of SLE, in order to diagnose and manage this condition which can result in life-threatening complications with adverse maternal and perinatal outcomes.
Case presentation: A 32-year-old G5 P1+3 (alive) registered for antenatal care at 8 weeks’ gestation and was not known to have SLE at booking. She complained of malaise, fever, and joint pain at first contact. There was proteinuria at booking which persisted throughout her pregnancy alongside other complaints. She developed deep vein thrombosis, severe skin rashes, pre-eclampsia, eclampsia amongst other complications during the course of the pregnancy and at puerperium. Result of antinuclear antibody test was markedly elevated, anti-double stranded DNA antibody test was positive and anti-Smith antibody test was borderline. Her care was multi-disciplinary approach and she had caesarean delivery at term. The baby had neonatal lupus and late neonatal demise from complications of neonatal heart block.
Conclusion: Like a black cat in a dark night, SLE in pregnancy, a rare medical condition which we seldom encounter in our busy clinics could be missed especially in unsuspecting patients. Persistent proteinuria with skin rash should therefore raise a high index of suspicion, which should trigger a search for this life-threatening disease in pregnancy. Instituting the right management early in pregnancy with a multi-disciplinary approach will improve both maternal and foetal outcome and subsequently reduce maternal and perinatal morbidity and mortality.
Keywords: Systemic lupus erythematosus, Autoimmune, Multi-systemic disease, Life-threatening, Maternal and perinatal morbidity and mortality.
Cite this article: Meme FC, Igbafe AA, Aigere EOS, Njoku C, Zawua Z, Mbah MK, et al. Systemic lupus erythematosus in pregnancy; a rare complication at Federal Medical Centre, Yenagoa: a case report. Yen Med J. 2020;2(1):197–203.
- Hahn BH. Systemic lupus erythematosus. In: Fauci AS, Braunwald E, Kasper DL, eds. Harrison’s Principles of Internal Medicine. 17th ed. New York, USA: McGraw-Hill; 2008:2075.
- Lockshin MD, Sammaritano LR. Lupus pregnancy. Autoimmunity. 2003;36:33-40.
- Adelowo OO, Oguntona SA. Pattern of systemic lupus erythematosus among Nigerians. Clin Rheumatol. 2009;28(6):699-703.
- Dey ID, Coleman J, Kwarko H, Mate-Kole M. Outcome of pregnancy in patients with systemic lupus erythematosis at Korle-Bu Teaching Hospital. Ghana Med J. 2016;50(2):72-77.
- Cunningham FG, Kenneth JL, Steven IB, John CH, Dwight JR, eds. Connective tissue disorders. Williams Obstetrics. 23rd ed. New York, USA: McGraw-Hill; 2010:1146.
- Rahman A, Isenberg DA. Systemic lupus erythematosus. N Engl J Med. 2008;358(9):929-939.
- Moyssakis I, Tzioufas A, Triposkiadis F, Strateges N, Kyriakidis M. Severe aortic stenosis and mitral regurgitation in a woman with SLE. Clinical cardiol. 2002;25(4):194-196.
- Kozora E, Arciniegas DB, Filley CM, West SG, Brown M, Miller D, et al. Cognitive and neurologic status in patients with systemic lupus erythematosus without major neuropsychiatric syndromes. Arthritis Rheum. 2008;59(11):1639-1646. doi: 10.1002/art.24189