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Neonatal lupus: fetal myocarditis progressing to atrioventricular block in triplets

Department of Cardiology, Istituti Clinici di Perfezionamento, Milan, Italy

S Mannarino

Department of Cardiology, Istituti Clinici di Perfezionamento, Milan, Italy

P Salice

Department of Cardiology, Istituti Clinici di Perfezionamento, Milan, Italy

C Boschetto

Department of Cardiology, Istituti Clinici di Perfezionamento, Milan, Italy

L Trespidi

1st Obstetric-Gynecological Clinic, Istituti Clinici di Perfezionamento, Milan, Italy

B Acaia

1st Obstetric-Gynecological Clinic, Istituti Clinici di Perfezionamento, Milan, Italy

F Mosca

Department Neonatology, Istituti Clinici di Perfezionamento, Milan, Italy

R Cimaz

Department of Pediatrics, Istituti Clinici di Perfezionamento, Milan Italy

P L Meroni

Allergy and Clinical Immunology Unit, Department of Internal Medicine, University of Milan, IRCCS Istituto Auxologico Italiano, Milan, Italy, pierluigi.meroni{at}unimi.it

We report a case of neonatal lupus syndrome (NLS) in an in vitro fertilization induced triplet pregnancy. Echocardiographicsigns of myocarditiswere evident at the 21st week of gestation(w.g.) in twin I, with a subsequentdevelopmentof a complete atrioventricular(AV) block at the 25th w.g.; twin III also displayed echocardiographic signs of myocarditis at the same time. Treatment with dexamethasone (4mg/day) was started at the 25th w.g. A complete echocardiographicregression of the myocarditis signs was achieved, while AV block was unaffected.Caesarian section was performed at the 31.5 w.g. after a premature rupture of the membranes. Complete AV block was confirmed in twin I with a heart rate of 51beats/min that required a pacemaker implant 40 days after. Twin III developed a first-degree AV block that switched to a periodic second-degreeblock later, while twin II displayed only liver enzyme abnormalities.

Key Words: anti-Ro antibodies • congenital heart block • fetal echocardiography • neonatal lupus

Lupus, Vol. 12, No. 10, 775-778 (2003)
DOI: 10.1191/0961203303lu441cr


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