Systemic lupus erythematosus presenting with leukocytoclastic vasculitis and seizure during pregnancy

Mostafa A. Borahay, Brent C. Kelly, Hassan M. Harirah

Research output: Contribution to journalArticle

Abstract

Systemic lupus erythematosus (SLE) is a rare multisystem disease with a wide array of presentation and is a diagnostic challenge during pregnancy. A 20-year-old gravida 1 at 39 weeks' gestation was referred to our hospital for elevated blood pressure, headache, and history of seizure. She was admitted with the impression of severe preeclampsia. Intravenous magnesium sulfate for seizure prophylaxis and oxytocin for induction of labor were started. Primary lower-segment cesarean section was performed for nonreassuring fetal heart tracing. The postoperative course was complicated with fever requiring prolonged intravenous antibiotic therapy, appearance of violaceous skin lesions on the periungual areas of fingers and toes, recurrent seizures, and altered sensorium. Biopsy of the lesions revealed leukocytoclastic vasculitis (LCV) with thrombi. Laboratory workup confirmed SLE with a dramatic improvement of the patient's condition upon initiating intravenous steroid therapy. LCV and neuropsychiatric SLE are rare presentations of SLE during pregnancy, and obstetricians should be aware of them. Workup for SLE is warranted in cases with atypical presentation of preeclampsia that does not resolve with delivery.

Original languageEnglish (US)
Pages (from-to)431-436
Number of pages6
JournalAmerican journal of perinatology
Volume26
Issue number6
DOIs
StatePublished - Jun 1 2009
Externally publishedYes

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Keywords

  • Leukocytoclastic vasculitis
  • NPSLE
  • Neuropsychiatric systemic lupus erythematosus
  • Postpartum
  • Preeclampsia
  • Pregnancy
  • SLE
  • Seizures
  • Systemic lupus erythematosus

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

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