Rare Case of Systemic Lupus Erythematosus with Multiorgan Involvement in A Young Pregnant Women – A Case Report

Abstract

Systemic Lupus erythematosus (SLE) is an autoimmune disease that notoriously varies in presentation, course, andoutcome. Active Nephritis, especially if the neuropsychiatry component is involved, is associated with adverse pregnancy outcomessuch as Gestational hypertension, pre-eclampsia, and renal failure. Our aim is to elaborate on the case report of young pregnantwomen diagnosed with SLE with multiorgan involvement about its course and management and the need for a multidisciplinaryapproach. A 20-year-old primigravida at 33 weeks of gestation with no known co-morbidities previously came with a history offever for 2 days, abdominal pain, and bleeding per vagina. Given placental abruption, the patient underwent an emergency lowersegment cesarean section. The patient developed postpartum hemorrhage (PPH), which was managed medically. On POD#8(postoperative day 8), the patient had generalized tonic-clonic seizures (GTCS) and developed hematuria. On evaluation, itrevealed abnormal renal parameters suggestive of Pregnancy-related Acute Kidney Injury (PRAKI). The patient's condition did notimprove with conservative management. After immunological investigations, a renal biopsy was done, and the diagnosis wasconfirmed as SLE-LN III (Systemic lupus erythematosus-Lupus nephritis) with Neuropsychiatry component involvement. Hence,the patient was started on Hydroxychloroquine based on the National Institute of Health protocol, and her condition improved.Hence given the relatively high number of maternal and neonatal deaths, lupus pregnancies should be followed by a multidisciplinaryteam, including nephrologists, rheumatologists, and obstetricians experienced in high-risk pregnancies, and deliveries should beplanned in tertiary-care settings provided with neonatology intensive care units.