NEONATAL LUPUS ERİTEMATOZUSA BAĞLI HEMATOLOJİK, HEPATİK, NÖROLOJİK VE PULMONER TUTULUMUNUN GÖZDEN GEÇİRİLMESİ: HASTA BAZLI SİSTEMATİK LİTERATÜR TARAMASI

Yıl 2020, Cilt: 53 Sayı: 2, 120 - 124, 31.08.2020

Abdulsamet Erden , Emre Bilgin , Berkan Armağan , Alper Sarı Serdar Ceylan Yusuf Ziya Şener Benazir Hymabaccus Fatih Gürler Levent Kılıç

https://doi.org/10.20492/aeahtd.727505

Öz

Amaç: Neonatal lupus eritematozus, anti-SS-A/Ro ve anti SS-B/La antikorlarının transplasental geçişiyle fetal dokulara bağlanması sonucu ortaya çıkan edinsel otoimmün bir hastalıktır. Kütanöz, kardiyak, hepatik, nörolojik, akciğer ve hematolojik bulgularla ortaya çıkabilir. Literatürdeki bilgi birikimi daha çok kütanöz ve kardiyak tutulumu ağırlıklıdır. Bu çalışmanın amacı, literatür taraması yaparak hepatik, nörolojik, akciğer ve hematolojik tutulumumların gözden geçirilmesidir.

Gereç ve Yöntem: 1976 yılından Ağustos 2015 tarihini kapsayacak şekilde Pubmed Medline’da literatür taraması yapıldı. MeSH terimleri kullanılarak yayınlar belirlendi: (''konjenital kalp bloğu, neonatal lupus‘' (MeSH)), ‘'insanlar'', ''İngilizce'' ile kısıtlamaları yapılarak tarandı. Vakaların bilgilerinin hasta bazında raporlandığı makaleler son analize dahil edildi. Hematolojik, hepatik, nörolojik ve akciğer tutulumu olan NLE hastalarının demografik, klinik ve laboratuvar verileri kaydedildi.

Bulgular: Toplam 755 NLE hastasının verileri kaydedildi. Bu hastaların 117 (%15,5)’sinde hematolojik, 78 (%10,3)’inde hepatik, 10 (%1,3)’unda akciğer (%1.3) ve 9 (%1,2)’unda nörolojik tutulum saptanmıştır.

Sonuç: Neonatal lupus eritematozus’da hematolojik, hepatik, akciğer ve nörolojik tutulum, kardiyak ve cilt tutulumuna göre daha az görülmektedir. Buna ragmen, klinisyenler NLE yönetimi sürecinde görülebilen bu tutulumlar açısından uyanık olmalılardır.

Anahtar Kelimeler

Neonatal lupus eritematozus, hepatik tutulum, nörolojik tutulum, hematolojik tutulum

EVALUATION OF HEMATOLOGICAL, NEUROLOGICAL, HEPATIC AND PULMONARY INVOLVEMENTS OF NEONATAL LUPUS ERYTHEMATOSUS: PATIENT-BASED SYSTEMATIC LITERATURE REVIEW

Öz

AIM: Neonatal lupus erythematosus (NLE) is an acquired autoimmune disease mainly caused by transplacental transition of anti-SS-A/Ro and anti SS-B/La antibodies. Cutaneous, cardiac, hepatic, neurologic, hematologic and pulmonary involvement can be seen. In current literature, data regarding cutaneous and cardiac involvement comprises the vast majority about NLE. Aim of this study was to review the current literature regarding hematologic, hepatic, neurologic, and pulmonary involvement of NLE in a case-based systematic review manner. MATERIAL AND METHOD: We conducted a systematic literature review on PubMed MEDLINE (from 01.01.1976 to 31.08.2015) with the MeSH words “congenital heart block, neonatal lupus’’. Search was limited to ‘’humans’’ and articles in English language. Articles reporting individual patient’s data were included into final analysis. Demographic, clinical and laboratory data of NLE cases with hematologic, hepatic, neurologic, and pulmonary involvement were recorded. RESULTS: Total of 755 NLE patients were recruited. Of these patients, 117 (15.5%) had hematologic involvement, 78 (10.3%) had hepatic involvement, 10 (1.3%) had pulmonary involvement and 9 (1.2%) had neurologic involvement. CONCLUSION: Hematologic, hepatic, pulmonary, and neurologic involvement were less common than cardiac and cutaneous involvement in NLE patients. Nonetheless, clinicians should keep in mind these involvements while managing the NLE patients. 

Anahtar Kelimeler

Neonatal lupus erythematosus, hepatic, neurologic, pulmonary, hematologic involvement

Kaynakça

• 1. Kurosaki K, Miyazaki A, Watanabe K, Echigo S. Long-term outcome of isolated congenital complete atrioventricular block pacing since neonatal period: experience at a single Japanese institution. Circ J 2008;72:81–7. 2. Wisuthsarewong W, Soongswang J, Chantorn R. Neonatal lupus erythematosus: clinical character, investigation, and outcome. Pediatr Dermatol 2011;28:115–21 3. Press J, Uziel Y, Laxer RM, Luy L, Hamilton RM, Silverman ED (1996) Long-term outcome of mothers of children with complete congenital heart block. Am J Med 100, 328–32. 4. Lee LA. The clinical spectrum of neonatal lupus. Arch Dermatol Res 2009;301(1):107-10. 5. Strandberg L, Winqvist O, Sonesson SE, Mohseni S, Salomonsson S, Bremme K, et al. Antibodies to amino acid 200-239 (p200) of Ro52 as serological markers for the risk of developing congenital heart block. Clin Exp Immunol 2008;154:30–7. 6. Moretti D, Cimaz R, Vannucci G, Marino A, De Martino M, Greco A. Cutaneous neonatal lupus: a case report and review of the literature. Int J Dermatol 2014; 53: 1508-1512 7. Erden A, Fanouriakis A, Kiliç L, Sari A, Armağan B, Bilgin E, Şener YZ, Hymabaccus B, Gürler F, Ceylan S, Kiraz S, Karadağ Ö, Boumpas D. Geoepidemiology and clinical characteristics of neonatal lupus erythematosus: a systematic literature review of individual patients’ data. Turk J Med Sci. 2020 Jan 9;50(1):281-290 8. Erden A, Kılıç L, Sarı A, Armağan B, Bilgin E, Ceylan S, Şener YZ, Hymabaccus B, Gürler F, Karadağ Ö, Kalyoncu U. Anti-Ro/La ilişkili konjenital kalp bloğunda prednisolonun uygunsuz kullanımı ve tedavi protokollerindeki heterojenite: 492 vakanın gözden geçirilmesi. j Turk Soc Rheumatol 2019;11:10-15. 9. McCuistion CH, Schoch EP. Possible discoid lupus erythematosus in a newborn infant: report of a case with subsequent development of acute systemic lupus erythematosus in the mother. Arch Dermatol Syph 1954; 70: 782-785. 10. Frankovich J, Sandborg C, Barnes P, Hintz S, Chakravarty E. Neonatal lupus and related autoimmune disorders of infants. NeoReviews 2008;9(5):e206-17. 11. Jayaprasad N, Johnson F, Venugopal K. Congenital complete heart block and maternal connective tissue disease. Int J Cardiol 2006;112(2):153-8. 12. Julkunen H, Kaaja R, Siren MK, Mack C, McCready S, Holthofer H, et al. Immune-mediated congenital heart block (CHB): identifying and counseling patients at risk for having children with CHB. Semin Arthritis Rheum 1998;28:97–106. 13. Buyon JP, Winchester RJ, Slade SG, Arnett F, Copel J, Friedman D, et al. Identification of mothers at risk for congenital heart block and other neonatal lupus syndromes in their children: comparison of enzyme-linked immunosorbent assay and immunoblot for measurement of anti–SS-A/Ro and anti–SS-B/La antibodies. Arthritis Rheum 1993;36:1263–73 14. Kurosaki K, Miyazaki A, Watanabe K, Echigo S. Long-term outcome of isolated congenital complete atrioventricular block pacing since neonatal period: experience at a single Japanese institution. Circ J 2008;72(1):81-7 15. Kobayashi R, Mii S, Nakano T, Harada H, Eto H. Neonatal lupus erythematosus in Japan: a review of the literature. Autoimmun Rev. 2009 May;8(6):462-6. doi: 10.1016/j.autrev.2008.12.013. Epub 2009 Jan 20. 16. Li YQ, Wang Q, Luo Y, Zhao Y. Neonatal lupus erythematosus: a review of 123 cases in China. Int J Rheum Dis. 2015 Sep;18(7):761-7. doi: 10.1111/1756-185X.12652. Epub 2015 Jul 14. 17. Wei Sun, Yuan TM, Chen LH, Yu HM. Clin Pediatr (Phila). Neonatal lupus erythematosus: three case reports and review of the Chinese literature. 2010 Jul;49(7):627-34. doi: 10.1177/0009922809350214. Epub 2010 Jan 28 18. Menon A, Silverman ED, Gow RM, Hamilton RM. Chronotropic competence of the sinus node in congenital complete heart block. Am J Cardiol. 1998 Nov 1.82:1119–21. A9. 19. Wisuthsarewong W, Soongswang J, Chantorn R. Neonatal lupus erythematosus: clinical character, investigation and outcome. Pediatr Dermatol 2011; 28: 115-121 20. Lee LA, Sokol RJ, Buyon JP. Hepatobiliary disease in neonatal lupus: prevalence and clinical characteristics in cases enrolled in a national registry. Pediatrics 2002; 109: e11. 21. Laxer RM, Roberts EA, Gross KR, et al. Liver disease in neonatal lupus erythematosus. J Pediatr 1990; 116:238-242. 22. Boh EE. Neonatal lupus erythematosus. Clin Dermatol 2004;22(2):125-8. 23. Buyon JP. Neonatal lupus syndromes. Curr Opin Rheum 1994; 6: 523-529. 24. Prendiville JS, Cabral DA, Poskitt KJ, Au S, Sargent MA. Central nervous system involvement in neonatal lupus erythematosus. Pediatr Dermatol 2003;20:60–7. 25. Boros CA, Spence D, Blaser S, Silverman ED. Hydrocephalus and macrocephaly: new manifestations of neonatal lupus erythematosus. Arthritis Rheum. 2007 Mar 15;57(2):261-6. 26. Yu Y, Du L, Pan J, Zheng J, Chen A, Chen L. A 10-year retrospective study of neonatal lupus erythematous in China. Asian Pac J Allergy Immunol. 2016 Jun;34(2):174-8. doi: 10.12932/AP0671.34.2.2016. 27. Watson RM, Lane AT, Barnett NK. Neonatal lupus erythematosus: a clinical, serological and immunogenetic study with review of the literature. Medicine (Baltimore). 1984;63:362–376. 28. Morton RL, Moore C, Coventry S, Langston C, Schikler K, Eid NS. Pulmonary capillaritis and hemorrhage in neonatal lupus erythematosus (NLE). J Clin Rheumatol. 2004 Jun;10(3):130-3.