A case of systemic lupus erythematosus suspected and diagnosed by pleurisy during pregnancy

Abstract

 We report a case where systemic lupus erythematosus（SLE）was diagnosed in a patient with pleurisy during pregnancy. The patient was a 29-year-old primiparous woman who had been treated for rheumatoid arthritis（RA）at the orthopedic department in our hospital and was prescribed Salazosulfapyridine（SASP）, which improved symptoms of RA. She conceived spontaneously, at which point SASP was discontinued, then visited our department at 19 weeks’ gestation for consultation due to the risk factor with RA. As the patient did not report any subjective symptoms at this point, it was agreed to have prenatal checkup at her primary facility. At 26 weeks’ gestation, she experienced difficulty breathing and visited the orthopedics department, but the symptoms did not improve. At 27 weeks’ gestation, she was referred to our department. At that point she was experiencing tachycardia, tachypnea, and orthopnea, and was hospitalized. Because of the high likelihood of premature birth, she was given Betamethasone in order to promote fetal lung maturation, which subsequently improved tachypnea, and orthopnea was no longer observed. SLE diagnosis was later confirmed, and we attributed her symptoms to pleurisy and pericarditis. Her symptoms improved with a steroid treatment, and we determined that the pregnancy was maintainable. She was discharged at 30 weeks’ gestation and had a live birth vaginally at 37 weeks’ gestation. SLE is a common disease in women of reproductive age, and its onset and flares during pregnancy have often been reported. This case showed that pregnancy could be maintained with immunosuppressive therapy, even when early termination of pregnancy is considered due to severe symptoms of autoimmune diseases.