A Severe Case of Postpartum Systemic Lupus Erythematosus: Clinical Challenges After Delivery
Abstract
Background: Systemic lupus erythematosus is a chronic autoimmune disease that frequently affects women of reproductive age. The disease can flare during pregnancy or postpartum, presenting complex clinical challenges due to hormonal fluctuations, immune system modulation, and multi-organ involvement. Severe postpartum flares, especially those involving neuropsychiatric and renal systems, require prompt diagnosis and targeted immunosuppressive therapy.
Case Presentation: We report a case of a 21-year-old primigravida woman who developed severe postpartum manifestations of SLE, three days following cesarean delivery at 32/33 weeks of gestation. The patient presented with seizures, altered mental status, and was diagnosed with neuropsychiatric SLE, lupus nephritis, peripartum cardiomyopathy (EF 45%), and systemic inflammatory response syndrome suspected due to urinary tract infection. Laboratory evaluation showed elevated ANA, hypocomplementemia, and significant proteinuria. The patient met the SLICC criteria and scored 18 on the SLEDAI, indicating severe disease activity. She was treated with pulse methylprednisolone (750 mg/day for 3 days), followed by tapering doses, with noted clinical improvement. At discharge, she was continued on hydroxychloroquine, corticosteroids, mycophenolic acid, and supportive therapies. EEG and CT scan findings were unremarkable, while echocardiography confirmed PPCM. The patient remained clinically stable and was transitioned to outpatient follow-up.
Conclusion: This case highlights the complexity of diagnosing and managing severe postpartum SLE, particularly in primigravida patients with multiorgan involvement. Early recognition and aggressive immunosuppressive treatment are critical to improving outcomes. Multidisciplinary care and close postpartum monitoring remain essential in the management of high-risk SLE patients.
Keywords: Systemic lupus erythematosus, postpartum flare, neuropsychiatric SLE, lupus nephritis
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