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.
KEYWORDS
Leukocytoclastic vasculitis - systemic lupus erythematosus - SLE - pregnancy - postpartum
- seizures - preeclampsia - neuropsychiatric systemic lupus erythematosus - NPSLE
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Hassan M HarirahM.D.
Department of Obstetrics & Gynecology, University of Texas Medical branch
Galveston, TX 77555-0587
Email: hmharira@utmb.edu
