This 33 year old woman had a history of SLE onset at the age of 29 with Raynaud's phenomenon, malar rash and poliarthritis. Laboratory investigations revealed antinuclear, anti-nDNA and anti-SS-A autoantibodies. The patient had a SLE riesacerbation during the fourth month of her first pregnancy with the sudden appearance of proteinuria (approx. 6 g/d). Renal biopsy was indicative of a membranoprolipherative lupus glomerulonephritis. She was therefore treated with high dose methylprednisolone and azathioprine with sufficient control of the renal involvement but not a complete resolution of the skin lesions.
A deep inter-relationship exists between SLE and pregnancy and many studies indicate that a flare-up of disease activity may be observed in a significant proportion of SLE patients during pregnancy. Moreover, pregnancy may induce or worsen a pre-existing renal involvement and a small percentage of patients develop a permanent renal function deterioration.
Therefore, the pregnant SLE patient should be carefully monitored for disease activity and major organ involvement. Prompt and adequate treatment adjustment and the use of "prophylactic corticosteroids" could be useful in selected patients.