妊娠引发的三重自身免疫(桥本甲状腺炎、抗磷脂综合征和系统性红斑狼疮)

S. Junejo
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引用次数: 0

摘要

我们描述了一例22岁女性首次怀孕引发桥本甲状腺炎(HT)、抗磷脂综合征(APS)和系统性红斑狼疮(SLE)的病例。病例报告:一个22岁的女性被诊断为HT左甲状腺素在早期妊娠。妊娠21周,患者发生宫内死胎,进行药物流产。SLE工作包括抗核抗体和抗双链DNA阳性。她接受肾活检,发现膜性和系膜性增生性狼疮性肾炎。诊断SLE和APS。开始抗凝治疗。SLE治疗开始使用强的松、霉酚酸酯和羟氯喹,症状完全缓解。我们报告一位23岁的孕妇首次怀孕,患有MGN和严重肾病综合征,并发APLA综合征。患者在短时间内给予依诺肝素、阿斯匹林硫唑嘌呤和强的松治疗,并静脉滴注速尿和白蛋白。由于母体和胎儿状况恶化,她在30周时分娩。讨论:APS是一种具有多种表现的血栓性疾病,最常见的是静脉和动脉血栓栓塞和复发性妊娠丢失。怀孕可能引发潜在的APS,这很可能是导致流产的原因。妊娠期新发SLE是罕见的。然而,在我们的病例中,贫血、血小板减少症和蛋白尿使我们正确诊断SLE。由于激素的变化和不稳定性,HT与较高的不孕症和早期流产率有关。然而,APS和HT在孕妇中的相关性尚未得到很好的认识。结论:我们在这里提出了一个由妊娠引发的新发三重自身免疫性疾病的具有挑战性的病例。临床医生应该意识到这种关联,并在怀孕期间新发HT的患者中启动SLE和APS的早期自身免疫工作。在这种情况下,新生儿和产妇取得了成功的结局。患者的病史显示血小板减少症和APLA综合征,并继续长期使用依诺肝素治疗。分娩后肾活检显示膜性MGN II-III期。在这里,我们提出了一个成功怀孕和胎儿结局的年轻妇女与APLA综合征和MN的情况下。关键词:妊娠诱发桥本甲状腺炎、抗磷脂综合征、系统性红斑狼疮
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Pregnancy-triggered triple autoimmunity (Hashimoto’s thyroiditis, antiphospholipid syndrome and systemic lupus erythematosus)
Introduction: We describe a case of 22 year old female with her first pregnancy triggered Hashimoto’s thyroiditis (HT), Antiphospholipid Syndrome (APS) and Systemic Lupus Erythematosus (SLE). Case Report: A 22 year old female was diagnosed with HT on levothyroxine during the early first trimester. During 21 weeks of gestation patient has intrauterine fetal demise and underwent medical abortion. SLE work up including antinuclear antibody and anti-double stranded DNA were positive. She underwent kidney biopsy, which revealed membranous and mesangial proliferative lupus nephritis. Diagnosis of SLE and APS was made. Treatment with anticoagulation therapy was started. SLE therapy was initiated with prednisone, mycophenolate mofetil and hydroxychloroquine with complete resolution of symptoms.We report a 23-year-old gravida in her first pregnancy, suffering from MGN and severe nephrotic syndrome, complicated by APLA syndrome. The patient was treated with enoxaparin, aspirin azathioprine, and Prednisone for a short time, in addition to furosemide and albumin intravenously. She was delivered at 30 weeks due to deteriorating maternal and foetal conditions. Discussion: APS is a prothrombotic disorder with various manifestations, most commonly venous and arterial thromboembolism and recurrent pregnancy loss. Pregnancy may trigger an underlying APS, which may well be the causative for the miscarriage. New onset SLE during pregnancy is rare. However, in our case, the anemia, thrombocytopenia, and proteinuria led us to the correct diagnosis of SLE. HT is associated with higher rates of infertility and early miscarriages, due to the associated hormonal changes and instability. However, the association of APS and HT is not well recognized in pregnant women. Conclusion: We present here a challenging case of new-onset triple autoimmune disorders trigged by pregnancy. Clinicians should be aware of this association and initiate early autoimmune work up for SLE and APS in patients with new onset of HT during pregnancy. A successful neonatal and maternal outcome was achieved in this case. The patient's history revealed thrombocytopenia and APLA syndrome and continues to be treated chronically with enoxaparin. Kidney biopsy performed after delivery showed membranous MGN stage II-III. Herein, we present a case of successful pregnancy and foetal outcome in a young woman with APLA syndrome and MN. Keywords: Pregnancy triggered Hashimoto’s thyroiditis, Antiphospholipid Syndrome and Systemic Lupus Erythematosus
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