Placental changes in a first trimester missed abortion in maternal systemic lupus erythematosus with antiphospholipid syndrome; a case report and review of the literature.

The placental lesions generally attributed to the effects of systemic lupus erythematosus (SLE) on the decidual and placental villi include decidual vasculopathy, placental infarcts and possibly intrauterine growth retardation. The maternal decidual vessels in SLE show a lesion termed "acute atherosis" which is histologically similar to acute vascular rejection in a transplanted kidney. These changes can be so extensive as to result in complete vascular occlusion, decreased placental perfusion and resultant placental villous infarction. In currettings from products of conception in the first trimester, acute atherosis is a rare finding. We describe striking decidual vasculopathy and extensive villous infarction in a case of a first trimester missed abortion in a patient with SLE who had anticardiolipin antibodies (ACL), both immunoglobulin (IgG) and IgM, and lupus anticoagulant (LA) in her serum. To the best of our knowledge, this is the first report of acute atherosis and villous infarction in a first trimester placenta in association with SLE and/or ACL and LA. Pathologists should be aware of these changes and alert clinicians to the possibility of SLE or antiphospholipid and/or anticardiolipin antibodies.