Key result
Maternal dexamethasone resolves fetal myocarditis in neonatal lupus triplets but fails to reverse AV block.
Why the study?
Neonatal lupus syndrome can cause fetal myocarditis progressing to atrioventricular block, but detailed case descriptions in triplets are rare.
Case Report (n=3)
In a triplet pregnancy with neonatal lupus syndrome, maternal dexamethasone therapy resolved fetal myocarditis but failed to prevent the progression of atrioventricular block.
Answers are grounded in this paper and cite their sources.
Hypothesis-generating for maternal dexamethasone in fetal myocarditis due to neonatal lupus; leaves open its role in AV block.
We report a case of neonatal lupus syndrome (NLS) in an in vitro fertilization induced triplet pregnancy. Echocardiographic signs of myocarditis were evident at the 21st week of gestation (w.g.) in twin I, with a subsequent development of 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 echocardiographic regression 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 51 beats/min that required a pacemaker implant 40 days after. Twin III developed a first-degree AV block that switched to a periodic second-degree block later, while twin II displayed only liver enzyme abnormalities.
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Fesslová et al. (2003) conducted a case report in Neonatal lupus syndrome (NLS) with fetal myocarditis and atrioventricular block (n=3). Dexamethasone was evaluated on Echocardiographic regression of myocarditis signs and AV block progression. Maternal treatment with dexamethasone (4mg/day) achieved complete echocardiographic regression of fetal myocarditis in triplets with neonatal lupus syndrome, but did not reverse atrioventricular block.
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