PMC6304583_01
PMC6304583_02
The levels of the simplified disease activity index (SDAI), which was the sum of the number of tender joints, the number of swollen joints, patient global assessment of disease activity by visual analogue scale (VAS), care provider global assessment of disease activity by VAS, and the levels of C-reactive protein (CRP) (mg/dL), and serum C-reactive protein (CRP) from the onset of rheumatoid arthritis (RA) at 31 years and 3 months old to 133 days after the current delivery. (a) The levels of SDAI and CRP from 31 years and 3 months old to 32 years and 11 months old when she became pregnant for the first time, which resulted in intrauterine fetal death (IUFD) at 9 weeks of gestation. (b) The levels of SDAI and CRP from 32 years and 11 months old to 35 years and 2 months old when she became pregnant for the second time, which also resulted in IUFD at 7 weeks of gestation. (c) The levels of SDAI and CRP from 35 years and 2 months old to postpartum day 133 in the delivery. The used drugs are shown at the top of the charts. wk, weeks of gestation; y, years; m, months; C/S, cesarean section; POD, postoperative days.
CRIOG2018-7438676.001.jpg
PMC6304583_03_CRIOG2018-7438676.001.jpg
fig1
Etanercept at 25 mg/day, twice a week, was restarted 42 days after delivery; and prednisolone was changed from 2.5 to 1.0 mg/day 133 days after delivery (Figure 1(c)).
PMC6304583_03
The levels of the simplified disease activity index (SDAI), which was the sum of the number of tender joints, the number of swollen joints, patient global assessment of disease activity by visual analogue scale (VAS), care provider global assessment of disease activity by VAS, and the levels of C-reactive protein (CRP) (mg/dL), and serum C-reactive protein (CRP) from the onset of rheumatoid arthritis (RA) at 31 years and 3 months old to 133 days after the current delivery. (a) The levels of SDAI and CRP from 31 years and 3 months old to 32 years and 11 months old when she became pregnant for the first time, which resulted in intrauterine fetal death (IUFD) at 9 weeks of gestation. (b) The levels of SDAI and CRP from 32 years and 11 months old to 35 years and 2 months old when she became pregnant for the second time, which also resulted in IUFD at 7 weeks of gestation. (c) The levels of SDAI and CRP from 35 years and 2 months old to postpartum day 133 in the delivery. The used drugs are shown at the top of the charts. wk, weeks of gestation; y, years; m, months; C/S, cesarean section; POD, postoperative days.
CRIOG2018-7438676.001.jpg
PMC6304583_03_CRIOG2018-7438676.001.jpg
fig1
Etanercept at 25 mg/day, twice a week, was restarted 42 days after delivery; and prednisolone was changed from 2.5 to 1.0 mg/day 133 days after delivery (Figure 1(c)).
Systolic blood pressure (SBP) and diastolic blood pressure (DBP) during pregnancy and the puerperal period. (a) SBP and DBP during pregnancy. Solid jagged lines indicate SBP, whereas broken jagged lines indicate DBP. (b) SBP and DBP from delivery to 16 days after delivery. Seizure occurred 5 and 7 days after delivery.
CRIOG2018-7438676.002.jpg
PMC6304583_03_CRIOG2018-7438676.002.jpg
fig2
A tonic-clonic seizure abruptly occurred without either hypertension or proteinuria 5 days after delivery; her blood pressure at the first seizure was 113/78 mmHg, and that at the second seizure was 109/72 mmHg (Figure 2).
(a) CT image 5 days after delivery, just after the occurrence of tonic-clonic seizure. Arrow indicates intraparenchymal hemorrhage with 2 cm diameter in the right frontal lobe. (b) FLAIR image on MRI 5 days after delivery, just after the occurrence of tonic-clonic seizure. Arrowhead indicates subarachnoid hemorrhage at the right Sylvian fissure. (c) T2-weight image on MRI 5 days after delivery, just after the first seizure. (d) FLAIR image on MRI 5 days after delivery. (e) DWI on MRI 5 days after delivery. (f) ADC mapping on MRI 5 days after delivery. (g) CT image 7 days after delivery, just after the second tonic-clonic seizure. (h) T2-weighted image on MRI 34 days after delivery. (i) FLAIR image on MRI 34 days after delivery. (j) DWI on MRI 34 days after delivery. (k) ADC mapping on MRI 34 days after delivery. CT, computed tomography; MRI, magnetic resonance imaging; POD, postoperative days; T2W1, T2-weighted; FLAIR, fluid-attenuated inversion recovery; DWI, diffusion-weighted image; ADC, apparent diffusion coefficient.
CRIOG2018-7438676.003.jpg
PMC6304583_03_CRIOG2018-7438676.003.jpg
fig3
Computed tomography (CT) disclosed intraparenchymal hemorrhage with 2 cm diameter in the right frontal lobe (Figure 3(a)) and a fluid-attenuated inversion recovery (FLARE) image obtained by magnetic resonance imaging (MRI) disclosed subarachnoid hemorrhage at the right Sylvian fissure (Figure 3(b)). MRI also revealed PRES in the bilateral frontal, temporal, and posterior lobes (Figures 3(c)-3(f)). Seizure recurred 2 days after the first one; however, cerebral images on CT did not change compared with those 2 days before the seizure (Figure 3(g)). MRI findings were ameliorated 1 month after the seizure (Figures 3(h)-3(k)).