Reference no: EM133929058

A 32-year old African-American woman, who is 26 weeks pregnant, presents to the emergency department with dyspnea, lower extremity edema, and fatigue. This is her first pregnancy. She has a history of systemic lupus erythematosus (SLE), which was diagnosed four years ago when she had a malar rash, oral ulcers, joint pains, and pleurisy along with a positive ANA anti-Smith, and anti-DS-DNA antibodies. Her last flare of SLE was ten months before conception when she was treated with oral steroids, and since then, her SLE has been in remission. She is currently on hydroxychloroquine. Vital signs show blood pressure 170/100 mmHg, pulse 102/min, and temperature of 98 F. She has a maculopapular rash on her upper torso but no oral ulcers. She has 2+ pitting edema in the lower extremities. The cardiac and pulmonary exam is normal. No synovitis is appreciated on the joint exam. Laboratory evaluation reveals CBC with hemoglobin 11.5 mg/dL and normal WBC and platelet counts. Liver function tests and serum creatinine are normal. Serum uric acid is 9.0 mg/dL. Urinalysis shows the presence of protein but no casts. The urine protein/creatinine ratio is 1.0. Anti-DS-DNA and ANA are positive. C3 and C4 are normal.