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Masayuki Nishide,* Mayu Yagita,* Atsushi Kumanogoh Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan*These authors contributed equally to this workCorrespondence: Masayuki Nishide, Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan, Tel +81-6-6879-3831, Fax +81-6-6879-3839, Email nishide@imed3.med.osaka-u.ac.jpAbstract: TNF-alpha-targeted therapies during pregnancy is a topic of interest in rheumatology. Etanercept (ETN) is expected to have lower transplacental transfer, however, clinical evidence is lacking on the usefulness and safeness of continuing etanercept throughout pregnancy. We here described the first reported case of relapsing polychondritis where continuous use of ETN throughout pregnancy was required. The patient was a pregnant Japanese woman who presented with bilateral ear cartilage redness, swelling, saddle nose and severe subglottic oedema. Due to severe systemic and life-threatened disease, we decided to continue using ETN throughout pregnancy and resulted in successful vaginal delivery. The treatment with ETN was successful and TNF-alpha levels in umbilical cord blood were not affected. The infant did not have any signs of chondritis although levels of anti-type 2 collagen antibodies in maternal and umbilical cord blood were similar, suggesting that anti-type 2 collagen antibodies crossed the placenta. This case is an important clinical experience that strengthens the safety to continue ETN during the entire pregnancy if necessary.Keywords: etanercept, relapsing polychondritis, pregnancy, TNF-alpha, anti-type 2 collagen antibody

Additional file 2: Supplementary Fig. S1. Kaplan–Meier curves for progression-free survival (PFS). Supplementary Fig. S2. Analysis of chemokines and cytokines. Supplementary Fig. S3. Gating strategy for immune phenotyping and functional characteristics of T cells. Supplementary Fig. S4. Foxp3 expression in effector memory of CD4+ T cells in individual cases.

Additional file 1: Supplementary Table S1. Adverse Events. Supplementary Table S2. Immune phenotypes of CD4+ and CD8+ T cells.

Lupus enteritis and lupus cystitis are relatively rare manifestations of systemic lupus erythematosus. Some patients develop severe complications such as bowel perforation, infarction, obstruction, or irreversible bladder dysfunction. Early diagnosis is critical for management of lupus enteritis and cystitis. We report a 48-year-old Japanese man who presented with initial manifestations of abdominal pain, severe diarrhea, and bloody feces. The diagnosis was delayed due to atypical initial symptoms, resulting in clinical worsening. Physicians should be aware of typical computed tomography findings of lupus enteritis and lupus cystitis.