The objectives of this study were to determine whether antiphosholipid antibodies are associated with in vitro fertilization (IVF), and assess the potential biological effects of these antibodies. Sera from seventy infertile women (18 before IVF, 13 submitted to one IVF cycle and 39 after three cycles) and 28 healthy controls were collected. Anticardiolipin (anti-CL) and antiphosphatidylserine (anti-PS) antibodies, paraoxonase (PON) and Total Anti-oxidant Capacity of plasma (TAC) were measured. Anti-CL and anti-PS titres were significantly increased in treated patients compared with patients before treatment or controls (P < 0.001). There were no differences regarding anti-CL and anti-PS titres between controls and untreated patients nor when different types of infertility were considered. PON activity and TAC were significantly reduced in treated patients when compared to untreated and controls (P < 0.001; P < 0.002). PON correlated inversely with anti-CL and anti-PS IgG (r = -0.734; P < 0.001) and directly with TAC (r = 0.720, P < 0.001). In conclusion PON activity is decreased in women submitted to IVF treatment and is associated with the presence of antiphospholipid antibodies. These factors might contribute to the increased oxidative status found in these patients.

She had altered behaviour with agitation, disorientation, fluctuating consciousness, hallucinations, and altered sleep. On examination, she had malar rash, icterus, and hepatosplenomegaly. She also had catatonia, mutism, would stare intermittently, had low speech output and psychomotor retardation with rigidity. There was no focal deficit. Investigations revealed pancytopenia, transaminitis, conjugated hyperbilirubinemia, normal renal functions, antinuclear antibody (ANA) -positive (homogenous pattern), high anti-dsDNA with hypocomplementemia.Liver biopsy revealed steatosis with hepatitis. Screen for infections was negative, except CMV. Very high levels of CMV DNA in blood were noted on PCR. It was a clinical dilemma as to whether CMV was causative, co-infection or a re-activation due to immunosuppression. Magnetic resonance imaging (MRI) brain showed cortical atrophy. There was no evidence of any vascular involvement.She was treated with intravenous (IV) methylprednisolone, IV cyclophosphamide pulses and oral valganciclovir. Results A repeat CMV viral load done after six weeks of oral valganciclovir therapy was undetectable. She has been followed up for a period of 6 months. She has shown marked improvement in her neurological status and transaminases have normalised. Conclusions CMV is an important pathogen in patients with SLE; however its exact pathogenesis needs more research.