La Revue de médecine interne
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Systemic lupus erythematosus (SLE) is a complex multifactorial autoimmune disease depending on both intrinsic and environmental factors. Among the latter, the Epstein-Barr Virus (EBV) has long been suggested as one of the responsible factors for the onset and activity of lupus disease. ⋯ Also, there are abnormalities in humoral and cellular responses to EBV and lupus patients have impaired control of EBV, with higher blood viral loads. Interstingly, this virus seems to be able to promote disease activity, by promoting the survival of autoreactive B lymphocytes and the production of interferon-α, which are two pivotal mechanisms in the pathophysiology of lupus disease.
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The occurrence of acquired hemophilia during pregnancy or postpartum is rare (2 to 10 % in series). It is generally suspected in the presence of haemorrhagic manifestations (especially subcutataneous or mucosal bleeding) associated with an isolated prolongation of the activated partial thromboplastin time (APTT). The diagnosis is confirmed by the association of a low level of factor VIII (FVIII) and the presence of an anti-FVIII inhibitor. ⋯ The management of childbirth is particularly delicate in terms of haemorrhage, especially if the anti-FVIII inhibitor is still present, and must be prepared in a multidisciplinary manner. Finally, as with any acquired hemophilia, a relapse is possible, especially in the year following remission. During a subsequent pregnancy, the risk of recurrence is possible but should not be a contraindication to a new pregnancy.