Description We report a case of a 26 year old female, Gravida 2 Para 1 (G2P1) 30 weeks age of gestation (AOG), with shortness of breath and chest discomfort. History revealed 4 years prior, patient has been experiencing chronic urticaria in the face, abdomen and extremities aggravated by sunlight. Upon consult, she was given Prednisone 20mg twice daily and Chlorphenamine 4mg daily but was lost to follow up. Four years later, she was hospitalized due to joint pains, butterfly rashes and shortness of breath. Using the SLICC criteria (cutaneous, serositis, synovitis, FANA), patient was managed as SLE. Antiphospolipid and cardiolipin panels were negative. She was started on Hydroxychloroquine 200mg twice daily, Prednisone 20mg daily and Mycophenolate 1gram daily. However, discontinued her medications upon pregnancy. Few months later, she was readmitted for chest discomfort, shortness of breath and uterine contractions. She has red raised patched rashes on extremities, periorbital edema, saddle nose, and cauliflower ears. Hence, Relapsing Polychondritis on top of SLE, G2P1 30 weeks AOG on preterm labor was entertained. 2D echocardiogram revealed normal left ventricular size with normal systolic/diastolic function, ejection fraction of 64%, dilated left atrium with trivial pericardial effusion o 0.5cm. She was started on Dexamethasone 6mg every 12 hours for 4 doses, Nifedipine 10mg thrice daily, Hydroxycholoroquine 200mg daily, Enoxaparin 40mg every 12 hours and Colchine 0.5mg daily. Symptoms improved and preterm labor was controlled. She was discharged with the following medications: Hydroxychloroquine 200mg daily, Prednisone 20mg daily, Azathrioprine 50mg daily, and Aspirin 80mgdaily. After a few weeks, she successfully delivered a live term baby boy with no complications.
Conclusions Systemic Lupus Erythematosus with Relapsing Polychondritis overlap during pregnancy carry a high maternal and fetal risk. Thus, a multidisciplinary approach with close medical, obstetric, and neonatal monitoring is necessary to optimize both maternal and fetal outcome.
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