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[新生儿皮肤型红斑狼疮。必要的多学科协作]

[Neonatal cutaneous lupus. Necessary interdisciplinary collaboration].

作者信息

Stirnemann J, Fain O, Lachassinne E, Levet R, Carbillon L, Kettaneh A, Aurousseau M H, Uzan M, Thomas M

机构信息

Service de médecine interne, AP-HP, Université Paris-Nord, UPRES EA 3409, Hôpital Jean Verdier, Avenue du 14 juillet 93143 Bondy.

出版信息

Presse Med. 2002 Sep 21;31(30):1407-9.

Abstract

INTRODUCTION

Neonatal lupus erythematosus is a rare syndrome (affecting 5% of the children born of mothers with lupus), characterized essentially by cutaneous lesions and/or congenital auricular-ventricular heart block. It is due to the transplacental passage of maternal antibodies (anti-SSA or anti-SSB, or occasionally anti-U1RNP antibodies) into the fetal circulation.

OBSERVATION

We report a case of neonatal lupus erythematosus, having appeared 4 weeks after birth. The 26 years old mother exhibited systemic lupus erythematosus concomitant to Gougerot-Sjögren's syndrome, with positive antinuclear factors (1/2560), native anti-DNA, anti-SSA and anti-SSB antibodies and anticardiolipin antibodies. During pregnancy, the mother had been treated with aspirin at the dose of 100 mg/day, followed by subcutaneous enoxaparin 0.4 ml/day, and combined with prednisone 10 mg/d and hydroxychloroquine 400 mg/day. Early and regular cardiac monitoring of the foetus was performed. The clinical examination and the electrocardiogram at birth were normal. Four weeks later, the infant presented with erythematous cutaneous lesions with atrophic center. No systemic treatment was initiated and the lesions partially regressed.

CONCLUSION

Cutaneous lesions can also appear after the 4th week of life. It is important that the pediatricians clinically monitor all the children born to mothers exhibiting anti-SSA or anti-SSB antibodies, at least during the first 7 months of life.

摘要

引言

新生儿红斑狼疮是一种罕见综合征(影响5%患有狼疮的母亲所生子女),主要特征为皮肤损害和/或先天性房室传导阻滞。它是由于母体抗体(抗SSA或抗SSB,偶尔为抗U1RNP抗体)经胎盘进入胎儿循环所致。

病例报告

我们报告一例出生4周后出现的新生儿红斑狼疮病例。这位26岁的母亲患有系统性红斑狼疮合并古德-施约格伦综合征,抗核因子阳性(1/2560),抗天然DNA、抗SSA和抗SSB抗体以及抗心磷脂抗体阳性。孕期,母亲接受了每日100毫克阿司匹林治疗,随后皮下注射每日0.4毫升依诺肝素,并联合每日10毫克泼尼松和每日400毫克羟氯喹治疗。对胎儿进行了早期定期心脏监测。出生时的临床检查和心电图均正常。四周后,婴儿出现中心萎缩的红斑性皮肤损害。未进行全身治疗,皮损部分消退。

结论

皮肤损害也可在出生后第4周后出现。重要的是,儿科医生应对所有母亲有抗SSA或抗SSB抗体的新生儿进行临床监测,至少在出生后的前7个月。

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