Preeclampsia as a Manifestation of New-Onset Systemic Lupus Erythematosus during Pregnancy: A Case-Based Literature Review

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).

Early Onset Pre-Eclampsia with Nephrotic Range Proteinuria as the Initial Manifestation of Lupus Nephritis: Report of three cases

“…Miyamoto et al . found eight out of 11 patients diagnosed with new-onset SLE during pregnancy had pre-eclampsia upon initial presentation, while three developed pre-eclampsia after SLE was diagnosed 3. All cases except one, who developed SLE post-partum, had pre-eclampsia detected in the third trimester of pregnancy.…”

“…Studies have found that pregnant women with SLE have worse manifestations than pregnant women without SLE and due to the hormonal changes and the increase in cytokines during pregnancy this disease may only be diagnosed for the first time during pregnancy 9,10. Most women with new-onset SLE are found to have a lower frequency of common symptoms suggestive of lupus at presentation, such as fever, arthritis, arthralgia, alopecia, oral ulcers and/or hypocomplementaemia, compared to those diagnosed in a non-pregnant state 2,3. Thrombocytopaenia is reported to occur in 10–40% of cases of new-onset lupus but in all present cases platelet counts were normal 5.…”

“…Systemic lupus erythematosus (SLE) is a multi-systemic autoimmune disorder affecting mostly women of child-bearing age. Nearly two-thirds of the women affected have lupus nephritis (LN) and usually have nephrotic-range proteinuria (>3.5 g/day) with active urinary sediments 2,3. Pre-eclampsia occurs in 10–15% of pregnant women with SLE and is more frequent in those with LN (20–40%) 4,5.…”

Lupus nephritis in pregnancy; a mini-review to current knowledge

“…The rate of active lupus nephritis in pregnancy is 4% to 30%, and in a person with a history of the previous recurrence of lupus nephritis is estimated to be 20% to 30% (10). However, there are rare reports of lupus nephritis as the first manifestation of disease in pregnancy (11). The active lupus nephritis is the biggest threat to the outcome of pregnancy in women with lupus.…”