NEONATAL LUPUS SYNDROME: THE ROLE OF MATERNAL SS-A(RO) AND SS-B(LA) ANTIBODIES

A patient, who developed systemic lupus erythematosus (SLE) five years after she gave birth to a daughter with congenital heart block, is presented. She was clinically normal at the time of that delivery. Her immunological investigations revealed antibodies against SS-A (Ro) and SS-B La) antigens. The aspects of latency until the development of clinical SLE, the role of such maternal antibodies in the development of fetal congenital heart block and the possibility of its prevention, using Dexamethasone and plasmapheresis during pregnancy are discussed. Bahrain Med Bull 1995;17: Women with systemic lupus erythematosus (SLE) have a higher frequency of miscarriage, intrauterine growth retardation, still birth and premature delivery. However 70-80 % of SLE pregnancies result in a live birth. In some instances the pregnancy continues until full term but the infant is born with bradycardia due to conduction system abnormalities. The congenital heart block, in addition to cutaneous lupus lesions and some hematological abnormalities are together termed Neonatal Lupus Erythematosus (NLE) and were described by Hull et al1 in 1966. Later work has shown a strong association between maternal SS-A(Ro) and SS-B(La) antibodies and the Neonatal Lupus Syndrome2. We report here a patient in whom SS-A(Ro), SS-B(La) antibody positive SLE was diagnosed five years after she gave birth to a daughter with the congenital complete heart block and at which time she was completely asymptomatic. We believe that this is the first such reported case in Bahrain. THE CASE HAF, a thirty one year old Egyptian housewife, was referred from the Primary Health Centre to the Skamania Medical Centre for the investigations of pyrexia of unknown origin