[Disseminated lupus erythematosus discovered during delivery: a difficult diagnosis]

The authors report a case of lupus showed in labour by the presence of generalised convulsions and coma after the crisis. This was followed by labile transitory hypertension, by massive proteinuria which cleared in 15 days, by major hyperthermia (higher than 39.5 degrees) and transitory agranulocytosis. The infant had a purely biological neonatal lupus. Pregnancy in a lupus patient has two risks: the mother's relapses of lupus, it is usual that renal failure is the worst of the prognostic features, but in this patient cerebral complications were much more serious. In the fetus there is a risk of spontaneous abortion linked to the anticardiolipin antibody level, and the risk of disease in the heart due to the anti-SSA (or anti-Ro) factor giving rise to congenital auriculo-ventricular blocks. The therapeutic possibilities are classically treated with immunosuppressants, mainly corticoids, which is added to low doses of aspirin. Plasmaphoresis and immunoglobulin treatments are being tried out.