Muscle weakness of the lower limbs after epidural anesthesia in a pregnant woman with undiscovered systemic lupus erythematosus

To the Editor:A 29-year-old nulliparous woman(weight 68 kg,height 159 cm)at 31±1 gestational weeks was admitted to the West China Second Hospital,complaining of lower limb edema for 3 months and dyspnea for 1 week,which had become more severe over the last 2 days.She was confirmed pregnant at a local hospital after experiencing amenorrhea for 40 days.All routine tests were normal until she was found to be anemic without symptoms at 18 gestational weeks.Her hemoglobin(Hb)was 77 g/L without thalassemia.After oral intake of a polysaccharide iron complex for 4 weeks,her Hb increased to 81 g/L with edema in her lower limbs.Urine testing was positive for protein(+)and occult blood(3+).At 30 gestational weeks,she felt chest distress,palpitations,and fatigue and could not maintain a supine position at night.A routine blood examination showed an Hb level of 67 g/L,and the transthoracic echocardiography showed mild mitral stenosis with moderate regurgitation and mild pericardial effusion.