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Quevedo S, Bekele C, Thompson PD, Philkhana M, Virani S, Consuegra A, Douglass P, Gertz AM. Peripartum cardiomyopathy and HELLP syndrome in a previously healthy multiparous woman: A case report. SAGE Open Med Case Rep 2021; 8:2050313X20979288. [PMID: 33425357 PMCID: PMC7758651 DOI: 10.1177/2050313x20979288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 11/11/2020] [Indexed: 01/19/2023] Open
Abstract
Peripartum cardiomyopathy is a type of dilated cardiomyopathy in which the exact etiology is uncertain. HELLP syndrome is characterized by a constellation of different clinical and laboratory findings, including hemolysis, elevated liver enzymes, and low platelets. Few case reports exist detailing successful diagnosis and management of postpartum HELLP syndrome, peripartum cardiomyopathy, and multisystem organ failure in a previously healthy woman. We herein report the case of a 39-year-old multiparous female with mild gestational hypertension, who presented in the third trimester with vaginal bleeding and was subsequently suspected to have intrapartum placental abruption leading to immediate Cesarean section, complicated by massive postpartum hemorrhage, necessitating care in the intensive care unit. HELLP syndrome, disseminated intravascular coagulation, and acute kidney injury requiring hemodialysis subsequently developed along with respiratory failure and peripartum cardiomyopathy. After diagnosis and proper management, the patient made a full recovery. Peripartum cardiomyopathy should remain on the differential for women with heart failure symptoms.
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Affiliation(s)
- Shany Quevedo
- Ross University School of Medicine, Miramar, FL, USA
| | - Caroline Bekele
- Wellstar Atlanta Medical Center, Family Medicine Residency Program, Atlanta, GA, USA
| | - Patrice D Thompson
- Wellstar Atlanta Medical Center, Family Medicine Residency Program, Atlanta, GA, USA
| | - Megan Philkhana
- Wellstar Atlanta Medical Center, Family Medicine Residency Program, Atlanta, GA, USA
| | - Sana Virani
- Wellstar Atlanta Medical Center, Family Medicine Residency Program, Atlanta, GA, USA
| | | | - Paul Douglass
- Wellstar Medical Group, Metro Atlanta Cardiovascular Medicine, Atlanta, GA, USA
| | - Alida M Gertz
- Wellstar Atlanta Medical Center, Family Medicine Residency Program, Atlanta, GA, USA
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Huang PZ, Du PY, Han C, Xia J, Wang C, Li J, Xue FX. Pre-eclampsia with new-onset systemic lupus erythematosus during pregnancy: A case report. World J Clin Cases 2019; 7:3800-3806. [PMID: 31799307 PMCID: PMC6887610 DOI: 10.12998/wjcc.v7.i22.3800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 09/30/2019] [Accepted: 10/05/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND New-onset systemic lupus erythematosus (SLE) during pregnancy and in the postpartum period is rare, especially when complicated with pre-eclampsia, which is difficult to diagnose accurately. Here, we report a patient with new-onset SLE and antiphospholipid syndrome during pregnancy, which presented as pre-eclampsia at admission.
CASE SUMMARY A 28-year-old primigravid woman was admitted to our hospital in the 27th wk of gestation with the primary diagnosis of severe pre-eclampsia. Although spasmolysis and antihypertensive therapy were administered since admission, the 24-h proteinuria of the 2nd day after admission reached 10311.0 mg. In the 47th h of admission, immunologic examinations revealed increased levels of anti-double stranded DNA antibody, anti-nuclear antibody, anti-cardiolipin antibody, anti-Sjögren’s syndrome-related antigen A antibody and anti-nucleosome antibody and decreased levels of complement C3 and C4. One hour later, ultrasonography of the lower limbs showed thrombus of the bilateral popliteal veins. The diagnosis of SLE and antiphospholipid syndrome was indicated. In the 54th h, the patient manifested with convulsion, dyspnea and blurred vision. Ten hours later, intrauterine death was revealed by ultrasonography. Emergent surgery consisting of inferior vena cava filter implantation and subsequent cesarean section was performed. Following glucocorticoid and anticoagulation therapy after delivery, the patient had an optimal response with improvements in symptoms and immunological markers.
CONCLUSION Obstetricians should be aware of the symptoms and immunological examination results to distinguish pre-eclampsia and underlying SLE for optimal pregnancy outcomes.
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Affiliation(s)
- Peng-Zhu Huang
- Department of Obstetrics and Gynecology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Pei-Yang Du
- Department of Obstetrics and Gynecology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Cha Han
- Department of Obstetrics and Gynecology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Jun Xia
- Department of Obstetrics and Gynecology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Chen Wang
- Department of Obstetrics and Gynecology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Jie Li
- Department of Obstetrics and Gynecology, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Feng-Xia Xue
- Department of Obstetrics and Gynecology, Tianjin Medical University General Hospital, Tianjin 300052, China
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Shakya S, Yang Z. New-onset systemic lupus erythematosus during pregnancy: A challenge in diagnosis. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.jrhm.2016.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Miyamoto T, Hoshino T, Hayashi N, Oyama R, Okunomiya A, Kitamura S, Ohtake N, Suga M, Miyamoto K, Takaoka A, Aoki T, Imamura Y, Nagano S, Kita M. Preeclampsia as a Manifestation of New-Onset Systemic Lupus Erythematosus during Pregnancy: A Case-Based Literature Review. AJP Rep 2016; 6:e62-7. [PMID: 26929873 PMCID: PMC4737630 DOI: 10.1055/s-0035-1566245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 09/11/2015] [Indexed: 12/13/2022] Open
Abstract
Introduction New-onset systemic lupus erythematosus (SLE) during pregnancy is rare and difficult to diagnose, especially in cases that manifest as preeclampsia. We report a patient with new-onset SLE that manifested as preeclampsia during pregnancy and provide a review of the literature to identify factors for a rapid diagnosis. Case A 32-year-old primigravid Japanese woman was diagnosed with severe preeclampsia and underwent emergent cesarean section at 29 weeks of gestation. Her hypertension and renal disorder gradually improved after the operation, but her thrombocytopenia and anemia worsened. SLE was diagnosed on postoperative day 5 by a comprehensive autoimmune workup. She was discharged on postoperative day 34 with remission. Conclusion Our case and previous reports suggest that distinguishing underlying SLE from preeclampsia in the third trimester is particularly difficult. Helpful factors for diagnosis of suspected SLE in these cases were persistence of symptoms and new atypical symptoms for preeclampsia revealed after delivery (e.g., fever, renal disorder, and thrombocytopenia).
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Affiliation(s)
- Taito Miyamoto
- Department of Obstetrics and Gynecology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Tatsuji Hoshino
- Department of Obstetrics and Gynecology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Nobutaka Hayashi
- Department of Obstetrics and Gynecology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Ruriko Oyama
- Department of Obstetrics and Gynecology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Asuka Okunomiya
- Department of Obstetrics and Gynecology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Sachiko Kitamura
- Department of Obstetrics and Gynecology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Noriko Ohtake
- Department of Obstetrics and Gynecology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Mami Suga
- Department of Obstetrics and Gynecology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kazunao Miyamoto
- Department of Obstetrics and Gynecology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Aki Takaoka
- Department of Obstetrics and Gynecology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Takuya Aoki
- Department of Obstetrics and Gynecology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yuko Imamura
- Department of Obstetrics and Gynecology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Seiji Nagano
- Department of Hematology and Clinical Immunology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Masato Kita
- Department of Obstetrics and Gynecology, Kobe City Medical Center General Hospital, Kobe, Japan
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Zhao C, Zhao J, Huang Y, Wang Z, Wang H, Zhang H, Xu H, Yang N. New-onset systemic lupus erythematosus during pregnancy. Clin Rheumatol 2013; 32:815-22. [PMID: 23358829 DOI: 10.1007/s10067-013-2180-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 12/14/2012] [Accepted: 01/17/2013] [Indexed: 10/27/2022]
Abstract
Few studies have been published focusing on the clinical features of new-onset systemic lupus erythematosus (SLE) during pregnancy. This study examined the clinical characteristics of SLE during pregnancy or puerperium. The clinical characteristics and serological parameters of 48 patients with onset of SLE during pregnancy were retrospectively compared with those of age-matched new-onset SLE patients who were diagnosed in a period of more than 12 months without pregnancy (n = 65) and age-matched preeclampsia patients (n = 48). SLE tended to occur during the first and second trimesters (33 and 42 %, respectively). Lupus nephritis (LN) and severe thrombocytopenia were more commonly seen in new-onset SLE during pregnancy than in patients without pregnancy (68.8 vs 35.4 % and 25 vs 9.2 %, respectively, p < 0.05). However, pregnant patients had lower frequency of fever, arthritis, arthralgia, alopecia, oral ulcer, and hypocomplementemia than the nonpregnant controls (p < 0.05). Compared to LN patients without pregnancy (n = 23), LN patients with pregnancy (n = 33) had more prominent proteinuria and nephrotic syndrome (p < 0.05). On the other hand, when compared to patients with preeclampsia, patients with new-onset SLE during pregnancy had early onset of symptoms during gestation and were characterized by presence of fever, malar lesion, autoantibodies, hypocomplementemia, hyperuricemia, active urinary sediment, and multi-organ involvement. In conclusion, patients with their first onset of lupus during pregnancy generally have more severe disease with higher prevalence of renal and platelet involvement.
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Affiliation(s)
- Chunmei Zhao
- Department of Rheumatolgoy, First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou 510080, People's Republic of China
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