1. Myopathy complicating lupus pregnancy
- Author
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Carla Giordano, Marialuisa Framarino-dei-Malatesta, Giulia d'Amati, Angelica Gattamelata, Maria Grazia Piccioni, Roberta Priori, and Guido Valesini
- Subjects
Adult ,medicine.medical_specialty ,Anti-nuclear antibody ,Biopsy ,Gastroenterology ,systemic lupus erythematosus ,Rheumatology ,Muscular Diseases ,Adrenal Cortex Hormones ,Pregnancy ,Internal medicine ,Medicine ,Humans ,Lupus Erythematosus, Systemic ,Myopathy ,Muscle, Skeletal ,Muscle biopsy ,Systemic lupus erythematosus ,Leukopenia ,medicine.diagnostic_test ,business.industry ,Hydroxychloroquine ,medicine.disease ,Rash ,myopathy ,pregnancy ,Pregnancy Complications ,Treatment Outcome ,Withholding Treatment ,Antirheumatic Agents ,Immunology ,Drug Therapy, Combination ,Female ,medicine.symptom ,business ,medicine.drug - Abstract
Systemic lupus erythematosus was diagnosed in a 34-year- old pregnant woman because of leukopenia, typical skin rash, clinical and biochemical signs of muscle involvement, and positive serology (antinuclear antibodies and antiYdouble-stranded DNA). Corticosteroids and hydroxychloroquine (HCQ) were started at 18 weeks of gestation with overall benefit except for muscle involvement, which proved re- sistant even to higher dose of corticosteroids and high-dose intravenous immunoglobulin. Muscle biopsy showed signs of HCQ toxicity, and the drug was stopped. After withdrawal, muscle involvement disappeared. Hydroxychloroquine could be safely reintroduced some months after delivery. It is hypothesized that pregnancy may have represented the second ''hit'' in this patient with systemic lupus erythematosus neces- sary for the rapid development of HCQ-related myopathy.
- Published
- 2013