Abstract
<title>Abstract</title> <p> Background Pregnant patients with systemic lupus erythematosus (SLE) are at a significantly increased risk for pregnancy complications such as pre-eclampsia and cardiopulmonary events, especially when they possess concomitant risk factors such as antiphospholipid syndrome. Case Presentation: A 29-year-old woman with SLE presented at 35 weeks gestation to the emergency room with dyspnea, hemoptysis, edema, and mildly elevated blood pressure. Her SLE was well-controlled without recent disease flares or concurrent antiphospholipid syndrome. She was diagnosed with atypical pneumonia and possible pre-eclampsia and discharged with antibiotics. Weeks later, just hours after an uneventful delivery, she developed sudden cardiopulmonary collapse requiring intubation, vasopressors, and extracorporeal membrane oxygenation (ECMO). She had a life-threatening prognosis with extremely poor hemodynamics and neurologic exam. Echocardiogram demonstrated biventricular dysfunction and severe mitral regurgitation. After a lengthy hospitalization, she eventually recovered, although her mitral regurgitation persisted. Years later, against medical recommendation and with continued mitral regurgitation, she conceived and delivered a healthy baby without any significant peri-partum complications. Conclusions This case illustrates that patients with SLE even without active disease nor antiphospholipid syndrome remain at significant risk for life-threatening pregnancy complications. In other words, lupus alone may confer high risk of complications. This case alternatively may suggest the inclusion of anti-β2 glycoprotein Ig <bold>A</bold> antibodies in APS diagnostic criteria. Finally, this patient’s persistent mitral regurgitation years later challenges the prevailing assumption that while stenotic lesions pose well-established risks in pregnancy, regurgitant lesions are relatively benign. Even in the absence of documented high-risk features, preconception cardiac counseling and multidisciplinary planning can help ensure positive outcomes. The patient’s more recent pregnancy without complications shows that, with careful clinical monitoring, patients with SLE can have successful pregnancy outcomes even after previous complications. </p>