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Barreto Mota R, Santos NR, Éden P, Rodrigues M, Brito I, Soares H. Lupus Pneumonitis: Case Report of a Rare Manifestation of Neonatal Lupus. J Investig Med High Impact Case Rep 2022; 10:23247096221077815. [PMID: 35389295 PMCID: PMC9016583 DOI: 10.1177/23247096221077815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Neonatal lupus is a rare entity, secondary to placental transfer of antibodies from
mothers with immune-mediated conditions. While pulmonary involvement is common in lupus,
its incidence in neonates is extremely rare, with very few cases being reported in the
literature. The authors report a case of a neonate whose mother was diagnosed with
systemic lupus erythematosus, with a prenatal diagnosis of third-degree atrioventricular
block. While initially admitted in the neonatal intensive care unit with no need for organ
support, he presented progressive respiratory failure, initially attributed to sepsis.
Favorable clinical progression after pacemaker placement allowed ventilatory weaning, but
respiratory failure was again apparent. Chest computer tomography revealed areas of
ground-glass lesions, raising the suspicion for lupus pneumonitis. He was started on
immunoglobulin and corticosteroids, with clinical improvement. The authors consider this
case to be relevant due to the rarity of acute lupus pneumonitis in neonates, alerting
that it must be considered a differential diagnosis in neonates with prolonged ventilator
dependency.
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Affiliation(s)
- Ricardo Barreto Mota
- Neonatology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Nuno Rodrigues Santos
- Neonatology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Paulo Éden
- Pediatric Cardiology Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Mariana Rodrigues
- Pediatric and Young Adult Rheumatology Unit, Pediatrics Department, Centro Hospitalar Universitário São João, Porto, Portugal.,Department of Obstetrics-Gynecology and Pediatrics, Faculty of Medicine, University of Porto, Portugal
| | - Iva Brito
- Pediatric and Young Adult Rheumatology Unit, Pediatrics Department, Centro Hospitalar Universitário São João, Porto, Portugal.,Department of Rheumatology, Faculty of Medicine, University of Porto, Portugal
| | - Henrique Soares
- Neonatology Department, Centro Hospitalar Universitário de São João, Porto, Portugal.,Department of Obstetrics-Gynecology and Pediatrics, Faculty of Medicine, University of Porto, Portugal
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Derdulska JM, Rudnicka L, Szykut-Badaczewska A, Mehrholz D, Nowicki RJ, Barańska-Rybak W, Wilkowska A. Neonatal lupus erythematosus - practical guidelines. J Perinat Med 2021; 49:529-538. [PMID: 33470961 DOI: 10.1515/jpm-2020-0543] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 12/11/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Neonatal lupus erythematosus is an autoimmune disease acquired during fetal life as a result of transplacental passage of maternal anti-Sjögren's-syndrome-related antigen A (anti-SSA/Ro), anti-Sjögren's-syndrome-related antigen B (anti-SSB/La) or anti-U1 ribonucleoprotein (anti-U1-RNP) antinuclear autoantibodies. CONTENTS Clinical manifestations include skin lesions, congenital heart block, hepatobiliary involvement and cytopenias. Most of the disorders disappear spontaneously after clearance of maternal antibodies. Cardiac symptoms, however, are not self-resolving and often pacemaker implantation is required. Diagnosis is based on clinical presentation and the presence of typical antibodies in the mother's or infant's serum. OUTLOOK Neonatal lupus erythematosus may develop in children born to anti-SSA/Ro or anti-SSB/La women with various systemic connective tissue diseases. However, in half of the cases, the mother is asymptomatic, which may delay the diagnosis and have negative impact on the child's prognosis. Testing for antinuclear antibodies should be considered in every pregnant woman since early treatment with hydroxychloroquine or intravenous immunoglobulin (IVIG) has proven to be effective in preventing congenital heart block.
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Affiliation(s)
| | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | | | - Dorota Mehrholz
- Department of Dermatology, Medical University of Gdańsk, Gdańsk, Poland
| | - Roman J Nowicki
- Department of Dermatology, Medical University of Gdańsk, Gdańsk, Poland
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Maltret A, Morel N, Levy M, Evangelista M, Malekzadeh-Milani S, Barbet P, Costedoat-Chalumeau N, Bonnet D. Pulmonary hypertension associated with congenital heart block and neonatal lupus syndrome: A series of four cases. Lupus 2020; 30:307-314. [PMID: 33198562 DOI: 10.1177/0961203320973073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Neonatal lupus syndrome has multisystemic manifestations among which pulmonary involvement has been rarely reported. We describe the clinical presentation, management, and outcome of a series of four neonates who developed reversible pulmonary hypertension associated with auto-immune congenital complete heart block. METHOD Data from the French registry of neonatal lupus syndrome were retrospectively reviewed. RESULTS Between 2000 and March 2020, 231 children were included in the French registry, four/73 followed in our institution developed pulmonary hypertension. Diagnosis was suspected on transthoracic echocardiography at a median age of 42 days [range 10-58], and confirmed by right heart catheterization in all; 2 of them where paced at time of diagnosis and 2 were not. All had some degree of hypoxemia and respiratory distress. Hypoxemia was always reversible under O2 et NO. Lung CT demonstrated ground glass anomalies in all. One patient had a lung biopsy consistent with pulmonary hypertension secondary to lung disease. Management included immunosuppressive therapy in 3 associated with sildenafil in 2. Pulmonary hypertension resolved in all at a median age of 4 weeks [range 3-6] after treatment initiation and after one year for the one child who did not receive specific treatment. CONCLUSION Clinical, hemodynamical, imaging and histological findings advocate for pulmonary hypertension associated with respiratory disease as a rare manifestation of neonatal lupus syndrome.
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Affiliation(s)
- Alice Maltret
- M3C-Necker, Hôpital Universitaire Necker-Enfants malades, Paris, France
| | - Nathalie Morel
- AP-HP, Hôpital Cochin, Centre de Référence Maladies Auto-immunes et Systémiques Rares, Paris, France
| | - Marilyne Levy
- M3C-Necker, Hôpital Universitaire Necker-Enfants malades, Paris, France.,Université de Paris, Paris, France
| | | | | | - Patrick Barbet
- Université de Paris, Paris, France.,Service d'Anatomo-Pathologie, APHP, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - Nathalie Costedoat-Chalumeau
- AP-HP, Hôpital Cochin, Centre de Référence Maladies Auto-immunes et Systémiques Rares, Paris, France.,Université de Paris, Paris, France
| | - Damien Bonnet
- M3C-Necker, Hôpital Universitaire Necker-Enfants malades, Paris, France.,Université de Paris, Paris, France
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Abstract
Neonatal lupus syndrome is associated with transplacental passage of maternal anti-SSA/Ro and anti-SSB/La antibodies. Children display cutaneous, hematological, liver or cardiac features. Cardiac manifestations include congenital heart block (CHB); endocardial fibroelastosis and dilated cardiomyopathy. The prevalence of CHB in newborns of anti-Ro/SSA positive women with known connective tissue disease is between 1 and 2% and the risk of recurrence is around 19%. Skin and systemic lesions are transient, whereas CHB is definitive and associated with significant morbidity and a mortality of 18%. A pacemaker must be implanted in 2/3 of cases. Myocarditis may be associated or appear secondly. Mothers of children with CHB are usually asymptomatic or display Sjogren's syndrome or undifferentiated connective tissue disease. In anti-Ro/SSA positive pregnant women, fetal echocardiography should be performed at least every 2 weeks from the 16th to 24th week gestation. An electrocardiogram should be performed for all newborn babies. The benefit of fluorinated corticosteroid therapy for CHB detected in utero remains unclear. Maternal use of hydroxychloroquine may be associated with a decreased recurrent CHB risk in a subsequent offspring. A prospective study is actually ongoing to confirm these findings.
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Moretti D, Cimaz R, Vannucci G, Marino A, De Martino M, Greco A. Cutaneous neonatal lupus: a case report and review of the literature. Int J Dermatol 2013; 53:1508-12. [DOI: 10.1111/j.1365-4632.2012.05809.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Davide Moretti
- Department of Paediatric Rheumatology; University of Florence; Anna Meyer Children's Hospital; Florence Italy
| | - Rolando Cimaz
- Department of Paediatric Rheumatology; University of Florence; Anna Meyer Children's Hospital; Florence Italy
| | - Gaia Vannucci
- Department of Paediatric Rheumatology; University of Florence; Anna Meyer Children's Hospital; Florence Italy
| | - Achille Marino
- Department of Paediatric Rheumatology; University of Florence; Anna Meyer Children's Hospital; Florence Italy
| | - Maurizio De Martino
- Department of Paediatric Rheumatology; University of Florence; Anna Meyer Children's Hospital; Florence Italy
| | - Antonella Greco
- Department of Paediatric Rheumatology; University of Florence; Anna Meyer Children's Hospital; Florence Italy
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Langston C, Dishop MK. Diffuse lung disease in infancy: a proposed classification applied to 259 diagnostic biopsies. Pediatr Dev Pathol 2009; 12:421-37. [PMID: 19323600 DOI: 10.2350/08-11-0559.1] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Thoracoscopic and open lung biopsies are being performed with increasing frequency in neonates and infants and are an important component of the diagnostic evaluation of respiratory compromise in these very young children. Diffuse lung disease in infancy includes a wide spectrum of developmental, genetic, inflammatory, infectious, and reactive disorders. The majority of the entities diagnosed in infancy (68%) in this retrospective lung biopsy series are seen almost exclusively in this age group and not in older children and adults. These include primary disorders of pulmonary and pulmonary vascular development, secondary disorders affecting prenatal and/or postnatal lung growth, genetic disorders of surfactant function, pulmonary interstitial glycogenosis, and neuroendocrine cell hyperplasia of infancy. Although the diagnostic approach to infant lung biopsies is guided primarily by the clinical history and imaging findings, all cases require careful assessment of alveolar growth, vascular architecture, interstitial cellularity, and histologic patterns associated with genetic abnormalities of surfactant metabolism. Recognition of one or more of these processes assists not only in treatment planning but also in further diagnostic evaluation and prognostication and may have implications for subsequent siblings and other family members. In this study, we have applied a classification system developed by a North American multicenter multidisciplinary group to lung biopsies seen at our institution and have used this material to describe and illustrate the spectrum of diffuse lung disease in infancy.
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Affiliation(s)
- Claire Langston
- Department of Pathology, Baylor College of Medicine and Texas Children's Hospital, 6621 Fannin Street, Houston, TX 77030, USA.
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