Pre-eclampsia with new-onset systemic lupus erythematosus during pregnancy: A case report

BACKGROUND New-onset systemic lupus erythematosus(SLE)during pregnancy and in the postpartum period is rare,especially when complicated with pre-eclampsia,which is difficult to diagnose accurately.Here,we report a patient with newonset SLE and antiphospholipid syndrome during pregnancy,which presented as pre-eclampsia at admission.CASE SUMMARY A 28-year-old primigravid woman was admitted to our hospital in the 27th wk of gestation with the primary diagnosis of severe pre-eclampsia.Although spasmolysis and antihypertensive therapy were administered since admission,the 24-h proteinuria of the 2nd day after admission reached 10311.0 mg.In the 47th h of admission,immunologic examinations revealed increased levels of antidouble stranded DNA antibody,anti-nuclear antibody,anti-cardiolipin antibody,anti-Sj?gren’s syndrome-related antigen A antibody and anti-nucleosome antibody and decreased levels of complement C3 and C4.One hour later,ultrasonography of the lower limbs showed thrombus of the bilateral popliteal veins.The diagnosis of SLE and antiphospholipid syndrome was indicated.In the 54th h,the patient manifested with convulsion,dyspnea and blurred vision.Ten hours later,intrauterine death was revealed by ultrasonography.Emergent surgery consisting of inferior vena cava filter implantation and subsequent cesarean section was performed.Following glucocorticoid and anticoagulation therapy after delivery,the patient had an optimal response with improvements in symptoms and immunological markers.CONCLUSION Obstetricians should be aware of the symptoms and immunological examination results to distinguish pre-eclampsia and underlying SLE for optimal pregnancy outcomes.

Neuropilin-1^(high) monocytes protect against neonatal inflammation

Neonates are susceptible to inflammatory disorders such as necrotizing enterocolitis(NEC)due to their immature immune system.The timely appearance of regulatory immune cells in early life contributes to the control of inflammation in neonates,yet the underlying mechanisms of which remain poorly understood.In this study,we identified a subset of neonatal monocytes characterized by high levels of neuropilin-1(Nrp1),termed Nrp1^(high) monocytes.Compared with their Nrp1low counterparts,Nrp1^(high) monocytes displayed potent immunosuppressive activity.Nrp1 deficiency in myeloid cells aggravated the severity of NEC,whereas adoptive transfer of Nrp1^(high) monocytes led to remission of NEC.Mechanistic studies showed that Nrp1,by binding to its ligand Sema4a,induced intracellular p38-MAPK/mTOR signaling and activated the transcription factor KLF4.KLF4 transactivated Nos2 and enhanced the production of nitric oxide(NO),a key mediator of immunosuppression in monocytes.These findings reveal an important immunosuppressive axis in neonatal monocytes and provide a potential therapeutic strategy for treating inflammatory disorders in neonates.