The Problem of Systemic Lupus Erythematosus Diagnosis In A Pregnant Woman With Early Clinical Manifestations Suspected Pulmonary Embolism

Author : A. Munandar, D. Rachmaniah, S. Widito
Upload Date : 19-04-2018

Introduction: Systemic lupus erythematosus (SLE) an unknown chronic inflammatory autoimmune disease with a broad spectrum of clinical presentations. Its course and prognosis are highly variable. The prevalence of SLE in USA was 52/100.000. In Indonesia, the prevalence of SLE is 0.5% from total population. The risk of death complications of pregnancy with SLE is about 20 times higher caused by pre-eclampsia, thrombosis, infection and blood-disorders.

Case presentation: A 34-year-old woman with 26-28?weeks of pregnancy presented to the emergence department with dyspnea. Initially, it is difficult to diagnose lupus because there was no signs and symptoms according to American College of Rheumatology criteria. Thus, the patient was diagnosed as Acute Pulmonary Embolism (wells score 6 Pesi 104). Physical examination found the presence of vasculitis, discoid rash, hair loss while tachycardia was found on examination of the heart. CT scan of thorax angiography excluded thrombotic events and confirmed pleural effusion and pericardial effusion. Positive ANA, anti-ds DNA antibody and coomb tests were determined. The patient was diagnosed SLE (7 of 11 ACR criteria) with Mex Sledai criteria 17 (severe flare). Patients were classified as severe SLE and the diagnosis of pulmonary embolism could be excluded.

The patient was treated with methylprednisolone pulse 500mg for 3 days and continued with 2x50mg azatioprine for 6 weeks and 2x16mg oral corticosteroids for 6 weeks. The patient's clinical condition improved and cutaneous manifestations disappear after SLE therapy. Sectio cesarian was performed at 32-34 weeks gestation with indication of premature rupture of membranes. Mother and her baby were survived.

Conclusion: Young woman with pregnancy complained of dyspnea was assessed as Acute Pulmonary Embolism for the first time. Then the patient was diagnosed with SLE from the ACR criteria. Patients were treated according to severe SLE therapy. The patient's clinical condition improved and cutaneous manifestations disappear after SLE therapy.

KEYWORDS : SLE, pregnancy, acute pulmonary embolism, ACR

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