Fetal proximal and distal limb anomalies following exposure to mycophenolate mofetil during pregnancy: A case report and review of the literature

Lupus ◽  
2021 ◽  
pp. 096120332110214
Author(s):  
Hoda MM Abdulaziz ◽  
Rasha Samir Shemies ◽  
Mohamed Taman ◽  
Alaa Mosbah ◽  
Ghada Elkannishy
Keyword(s):  
Mycophenolate Mofetil ◽  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
Intrauterine Growth Restriction ◽  
Unplanned Pregnancy ◽  
Wide Spectrum ◽  
Contraceptive Methods ◽  
Teratogenic Effects ◽  
Intrauterine Growth ◽  
Effective Contraceptive

Background Mycophenolate mofetil (MMF) is currently used in a wide spectrum of autoimmune diseases and has been rendered very effective in the management of systemic lupus erythematosus and lupus nephritis. MMF is known to be teratogenic (FDA category D) and therefore, women in childbearing period receiving MMF should be counselled to use effective contraceptive methods to avoid an unplanned pregnancy. Case A 22-year-old lady accidentally discovered to be pregnant while using MMF as a treatment of lupus nephritis which was replaced later on by azathioprine. After maternal and fetal evaluation, maternal lupus flare was confirmed and multiple fetal skeletal deformities associated with intrauterine growth restriction (IUGR) were diagnosed by 4-dimensional ultrasound. Termination of pregnancy was decided after shared decision making. Conclusion Women in childbearing period should be advised to postpone pregnancy for at least six weeks after stoppage of MMF therapy because of its potential teratogenic effects during pregnancy.

Antiphosphatidylserine/prothrombin Antibodies in Antiphospholipid Syndrome with Intrauterine Growth Restriction and Preeclampsia

2018 ◽  
Vol 45 (9) ◽  
pp. 1263-1272 ◽  
Author(s):  
Valentina Canti ◽  
Stefania Del Rosso ◽  
Marta Tonello ◽  
Roberta Lucianò ◽  
Ariela Hoxha ◽  
...  
Keyword(s):  
Antiphospholipid Syndrome ◽  
Lupus Erythematosus ◽  
Pregnancy Complications ◽  
Intrauterine Growth Restriction ◽  
Late Pregnancy ◽  
Additional Treatment ◽  
Growth Restriction ◽  
Intrauterine Fetal Death ◽  
Thrombotic Risk ◽  
Intrauterine Growth

Objective.Antibodies that recognize the phosphatidylserine/prothrombin complex (antiphosphatidylserine/prothrombin antibodies; aPS/PT) might reveal enhanced thrombotic risk in patients with systemic lupus erythematosus. Little is known about their association with pregnancy complications in the antiphospholipid syndrome (APS).Methods.We enrolled 55 patients with APS who were seeking pregnancy in 2 Italian hospitals. Antiphospholipid antibodies (aPL), including anticardiolipin antibodies, anti-β2-glycoprotein I antibodies, lupus-like anticoagulant, and aPS/PT antibodies were assessed, and the patients were prospectively followed for 24 months.Results.There were 65% (36/55) of the APS patients who had aPS/PT antibodies. Forty-seven pregnancies were followed, including 33 of aPS/PT+ patients. Forty-one of the 47 patients (87%) who initiated a pregnancy eventually gave birth to a child. The pregnancy duration and the mean newborn weight at delivery were significantly lower in aPS/PT+ than in aPS/PT− patients (33.1 ± 4.7 vs 36.2 ± 3.4 wks of gestation, respectively, and 2058 ± 964 g vs 2784 ± 746 g, respectively, p < 0.05). Late pregnancy complications, including intrauterine fetal death, preterm delivery, preeclampsia, and intrauterine growth restriction (IUGR), were more frequent in aPS/PT+ patients, independent of the therapy. Titers of aPS/PT IgG were significantly inversely correlated with the neonatal weight at delivery. Vascular injury, as reflected by thrombosis, fibrinoid necrosis, ischemic and hemorrhagic areas, and presence of chorangiomas characterized the IUGR placentas in the presence of aPS/PT.Conclusion.The aPS/PT antibodies might represent markers of aPL-related pregnancy complications, IUGR/preeclampsia in particular, and could help identify beforehand patients who may require additional treatment.

scholarly journals A patient with systemic lupus erythematosus and lupus nephritis: A 12-year follow-up

2011 ◽  
Vol 68 (8) ◽  
pp. 705-708
Author(s):  
Natasa Jovanovic ◽  
Jasmina Markovic-Lipkovski ◽  
Stevan Pavlovic ◽  
Biljana Stojimirovic
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Nephrotic Syndrome ◽  
Mycophenolate Mofetil ◽  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
Kidney Biopsy ◽  
Immunosuppressive Drugs ◽  
Systemic Lupus ◽  
Younger Women ◽  
The Right

Introduction. Systemic lupus erythematosus (SLE) is a chronic immunological disease causing a significant morbidity and mortality in younger women and involving several organs and systems, most often the kidneys, being consequently the incidence of lupus nephritis (LN) about 60%. Case report. We reported a 57 year-old patient with the diagnosed SLE in 1995. Pathohistological analysis of kidney biopsy revealed LN type V. The patient was treated with corticosteroid pulses and azathioprine during one year. A remission was achieved and maintained with prednisone, 15 mg daily. Nephrotic relapse was diagnosed in 2006 and the second kidney biopsy revealed recent kidney infarction due to extensive vasculitis. Soon, a cerebrovascul insult developed and CT-scan revealed endocranial infarctus. The patient was treated with corticosteroids and cyclophosphamide pulses (totally VI monthly pulses), and also with low-molecular heparine, anticoagulants and salicylates because of the right leg phlebothrombosis. After the pulses, the patient was adviced to take prednisone 20 mg daily and azothioprine 100 mg daily, and 6 months later mycophenolate mofetil because of persistent active serological immunological findings (ANA 1 : 320) and nephrotic syndrome. Mycophenolate mofetil was efficient in inducing and maintaining remission of nephrotic syndrome. Conclusion. The aim of LN treatment is to achieve and maintain remission, improve patients? outcome, reduce the toxicity of immunosuppressive drugs and the incidence of relapses. Mycophenolate mofetil was shown to be efficient in inducing and maintaining remission of nephrotic syndrome in the frame of LN.

scholarly journals Rituximab treatment for lupus nephritis: A systematic review

2020 ◽  
Vol 43 (2) ◽  
pp. E47-54
Author(s):  
Zijie Yuan ◽  
Qifang Xie ◽  
Xiaochuan Wu ◽  
Boyu Tan ◽  
Xianhua Zhang
Keyword(s):  
Systematic Review ◽  
Mycophenolate Mofetil ◽  
Complete Remission ◽  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
Activity Index ◽  
Remission Rate ◽  
Complete Remission Rate ◽  
Significant Difference ◽  
Total Remission

Purpose: We used the Cochrane systematic review to analyze the effectiveness and safety of rituximab for lupus nephritis. Methods: Systematic search was performed among Cochrane clinical controlled trials database, MEDLINE, MEDLINE-IN-Process and Other Non-Indexed Citations, EMBASE, EBSCO CINAHL, CNKI, VIP and Wanfang database from the establishment of the database to February 2016. The effectiveness and safety were evaluated in terms of the complete remission rate, total remission rate, urinary protein, Systemic Lupus Erythematosus Disease Activity Index changes and adverse events rate. Data were analyzed by the Review Manager Software version 5.3. Results: Five RCTs that met the inclusion criteria, including a total of 238 patients, were enrolled in our study. The results showed that the complete remission rate in rituximab group was a significantly higher than that of cyclophosphamide group. The difference between the two groups was statistically significant (OR=2.80, 95%CI(1.08,7.26), P=0.03). But there was no significant difference between the two groups in partial and total remission rate. The complete remission rate, partial remission rate and total remission rate in rituximab treatment group was similar compared with mycophenolate mofetil group and rituximab combined with cyclophosphamide group. The adverse reaction rate was also similar among the groups. Conclusion: The study systematically analyzed the effectiveness and safety of rituximab for lupus nephritis, which suggested that the complete remission rate of rituximab in the treatment of lupus nephritis was a significantly higher than that of cyclophosphamide group, while the effectiveness and safety was of no difference compared with cyclophosphamide and mycophenolate mofetil.

scholarly journals Mycophenolate Mofetil Therapy in Lupus Nephritis

1999 ◽  
Vol 10 (4) ◽  
pp. 833-839
Author(s):  
MARY ANNE DOOLEY ◽  
FERNANDO G. COSIO ◽  
PATRICK H. NACHMAN ◽  
MICHAEL E. FALKENHAIN ◽  
SUSAN L. HOGAN ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Mycophenolate Mofetil ◽  
Lupus Nephritis ◽  
Adverse Events ◽  
Serum Creatinine ◽  
Lupus Erythematosus ◽  
Transplant Rejection ◽  
Initial Therapy ◽  
Controlled Clinical Trials ◽  
The Mean

Abstract. Controlled clinical trials in renal transplantation have demonstrated that mycophenolate mofetil is well tolerated and has lower renal transplant rejection rates than azathioprine regimens. This study reports on the clinical experiences at two institutions with mycophenolate mofetil (MMF) for severe lupus nephritis. Twelve patients with relapsing or resistant nephritis previously treated with cyclophosphamide therapy and one patient who refused cyclophosphamide as initial therapy for diffuse proliferative nephritis but accepted MMF were included. During combined MMF/prednisone therapy, serum creatinine values remained normal or declined from elevated values: mean change in serum creatinine was -0.26 ± 0.46 μM/L, P = 0.039. Proteinuria significantly decreased: mean change in urine protein-to-creatinine ratios was -2.53 ± 3.76, P = 0.039. Decreased serum complement component C3 and elevated anti-double-stranded DNA antibody levels at baseline improved in some, but not all, patients. The mean initial dose of MMF was 0.92 g/d (range, 0.5 to 2 g/d). The mean duration of therapy was 12.9 mo (range, 3 to 24 mo). Adverse events included herpes simplex stomatitis associated with severe leukopenia (n = 1), asymptomatic leukopenia (n = 2), nausea/diarrhea (n = 2), thinning of scalp hair (n = 1), pancreatitis (n = 1), and pneumonia without leukopenia (n = 1). Recurrence of the pancreatitis led to discontinuation of MMF in this patient; all other adverse events resolved with dose reduction. It is concluded that MMF is well tolerated and has possible efficacy in controlling major renal manifestations of systemic lupus erythematosus. Controlled clinical trials are needed to define the role of MMF in the management of lupus nephritis.

Mycophenolate Mofetil for a Flare Child Lupus Nephritis: A Case Reports

2021 ◽  
Vol 2 (1) ◽  
pp. 113-118
Author(s):  
Gina Puspita ◽  
Desy Rusmawatiningtyas ◽  
Sumadiono
Keyword(s):  
Mycophenolate Mofetil ◽  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
Case Reports ◽  
High Dose ◽  
Common Complication ◽  
High Dose Corticosteroid ◽  
Steroid Dose ◽  
High Doses ◽  
Dose Corticosteroid

A B S T R A C TRenal involvement is the most common complication of systemic lupus erythematosus(SLE) and is also an important predictor of patient mortality. The incidence of flaresis estimated at 65% each year in patients with lupus nephritis. Therapy in lupusnephritis with flare also uses high doses of steroid agents and strongimmunosuppression agent. Mycophenolate mofetil (MMF) as a immunosuppressionagent tends to favor for flare in lupus nephritis. We describe a patient who had flarein lupus nephritis that resolved with high-dose steroid and MMF. The combination ofimmunosuppression agent and high-dose corticosteroid is an effective for control ofactive diseases. Cyclophosphamide as the steroid sparing agent was discontinuedbecause of adverse effect as well as hematuria. Partial remission was later achievedand maintained with MMF and corticosteroid after five month with protocol treatment.Thus, MMF while maintaining the steroid dose may induce remission for this case.

scholarly journals Successful Treatment of Hemophagocytic Lymphohistiocytosis Associated with Lupus Nephritis by Using Mycophenolate Mofetil

2017 ◽  
Vol 2017 ◽  
pp. 1-3 ◽  
Author(s):  
Takashi Nawata ◽  
Makoto Kubo ◽  
Kosaku Shiragami ◽  
Yukinori Nakamura ◽  
Masafumi Yano
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Mycophenolate Mofetil ◽  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
Hemophagocytic Lymphohistiocytosis ◽  
Corticosteroid Treatment ◽  
Immunosuppressive Drugs ◽  
Japanese Woman ◽  
Systemic Lupus ◽  
Old Japanese

An estimated 0.9% to 2.4% of patients with systemic lupus erythematosus (SLE) also have hemophagocytic lymphohistiocytosis (HLH). HLH associated with autoimmune diseases is often refractory to corticosteroid treatment; thus, additional immunosuppressive drugs, such as cyclosporine, cyclophosphamide, or tacrolimus, are required. Here, we describe the case of a 44-year-old Japanese woman who developed HLH associated with lupus nephritis. Initially, her HLH was refractory to treatment with a corticosteroid, tacrolimus, and mizoribine. However, alternative treatment with a corticosteroid, mycophenolate mofetil, and tacrolimus improved both her HLH and lupus nephritis. This case suggests the possibility of mycophenolate mofetil as a key drug for treating HLH associated with SLE.

scholarly journals Lupus Disease with Lupus Nephritis - 14 Years of Clinical-Biological Observations

2020 ◽  
Vol 17 (3) ◽  
pp. 61-69
Author(s):  
Cristina Buhoară ◽  
Nicoleta Petre ◽  
Mircea Penescu
Keyword(s):  
Mycophenolate Mofetil ◽  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
Nitrogen Retention ◽  
Pulse Therapy ◽  
Reduced Dose ◽  
Clinical Evolution ◽  
Azathioprine Treatment ◽  
Increased Risk ◽  
Dsdna Antibodies

AbstractWe present the case of a female patient diagnosed in 2004 with systemic lupus erythematosus, initially with joint and hematological damage complaint, for which she was treated with Methylprednisolone for 6 months. Subsequently, symptomatology and paraclinical screening raised the suspicion of renal impairment, a pulse therapy with Solumedrol and Cyclophosphamide was initiated, a total of 6 pulses. She is in the database of our Clinic since March 2008, when a renal biopsy was performed, revealing a class IV lupus nephritis, initiating treatment with Mycophenolate mofetil and Prednisone until 2010, when the dose of Prednisone is progressively reduced until cessation at the time of remission. Subsequently she presented two relapse episodes, recovered by pulse therapy with Methylprednisolone and Cyclophosphamide, followed by maintenance therapy with Mycophenolate mofetil and Prednisone with a good clinical evolution. In 2017 the patient has a pregnancy with favorable evolution (under treatment with Azathioprine), presenting normal values of cDNA, C3, C4 during the 9 months, but with a persistent nephrotic-range proteinuria; in these conditions gives birth physiologically at 37 weeks. During 2019 apparent remission is maintained (stationary nitrogen retention, anti-dsDNA antibodies within normal range), but with moderate anaemia and persistent, but diminished proteinuria (being under treatment with reduced dose Prednisolone and Mycophenolate mofetil); along the way proteinuria is accentuated again and it is decided to return to reduced dose Azathioprine treatment, with good clinical evolution.Conclusion. The presented case reinforces the idea of systematic monitoring of patients with SLE and the need for permanent adaptation of treatment especially when there is an increased risk of relapse. Pregnancy, paradoxically well tolerated, increases subsequently the risk of reactivation of lupus nephritis.

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