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Updated: Mar 14, 2026

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A severe lupus flare during pregnancy caused critical heart dysfunction. Prompt treatment, including pregnancy termination and immunosuppressants, led to significant cardiac recovery and resolution of heart failure symptoms.

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Area of Science:

  • Cardiology
  • Rheumatology
  • Obstetrics

Background:

  • Systemic lupus erythematosus (SLE) poses significant risks during pregnancy, particularly cardiovascular complications.
  • Pregnancy in SLE patients requires careful monitoring for flares and potential cardiac involvement.

Observation:

  • A 22-year-old pregnant woman with a history of lupus presented with hypertensive emergency and pulmonary edema at 18 weeks gestation.
  • Initial echocardiogram showed severe left ventricular dysfunction (ejection fraction 25%) and pericardial effusion.
  • Laboratory findings and cardiac MRI confirmed an acute lupus flare with lupus carditis and worsening left ventricular ejection fraction (LVEF) to 13%.

Findings:

  • Shared decision-making led to the patient's decision for medical termination of pregnancy due to severe maternal cardiac risks.
  • Initiation of immunosuppressive therapy, including cyclophosphamide and steroids, was crucial for managing the lupus flare.
  • Post-discharge cardiac MRI revealed substantial improvement in LVEF to 50% within 2 months.

Implications:

  • This case highlights the critical interplay between lupus flares, pregnancy, and severe cardiac dysfunction.
  • Aggressive immunosuppressive therapy can lead to significant cardiac recovery in lupus carditis.
  • Management requires a multidisciplinary approach and shared decision-making with the patient regarding pregnancy continuation and treatment.