[PubMed] [Google Scholar] 6. high-grade fever. Chest x-ray suggested multifocal pneumonia. Patient deteriorated despite antibiotics and intravenous (IV) fluids. She developed worsening anemia, leukopenia, and thrombocytopenia. Autoimmune work-up was positive for Coombs, antinuclear antibody, anti-smith antibody, and hypocomplementemia. Skin biopsy was consistent with SLE. SLE vasculitis was suspected. She required mechanical intubation for quick respiratory deterioration, with CT thorax suggesting ARDS. Bronchoscopy was carried out and confirmed DAH. Her course was further complicated with retinopathy and acute pancreatitis associated with SLE. She was treated with IV steroids, IV cyclophosphamide, and plasmapheresis, with significant clinical improvement and successful extubation. She delivered a healthy baby at 32 weeks gestation. Conclusions: Early acknowledgement and ONC212 initiation of treatment is critical to survival in DAH and requires a high index of clinical suspicion. Treatment includes high-dose steroids, cyclophosphamide, and plasma exchange. Pregnancy increases the risk of adverse end result in SLE. Seven cases of DAH in pregnant patients with SLE have been reported. Here, we statement a catastrophic presentation of DAH, acute pancreatitis, and retinopathy in a pregnant patient with newly diagnosed SLE. PCR and IgG/IgM antibody. Acid-fast bacilli cultures were unfavorable. HIV antigen/antibody combo (fourth-generation) was unfavorable. Her respiratory status deteriorated, requiring emergent endotracheal intubation and mechanical ventilation on day 4 of admission. Her hemoglobin decreased from 7.9 g/dL to 5.7 g/dL on day 4 of admission, with worsening leukopenia 2.6 K/dL, thrombocytopenia 119 000 K/dL, and lymphopenia. Her peripheral smear was unfavorable for indicators of hemolysis. The patient experienced an immunological workup summarized in Table 1. The patient experienced a positive Coombs test, lactate dehydrogenase (LDH) that ranged from 415 to 789 IU/L ONC212 (elevated), and haptoglobin at 109 (normal). Antinuclear antibody (ANA) was positive 1: 640 speckled pattern, anti-RNP 113, anti-Smith 103, match C3 (26), and match C4 ( 8). Unfavorable autoimmune serologies include anti-double-stranded DNA, anti-SSA/Ro, anti-SSB/La, and antiphospholipid antibodies. A skin biopsy was taken from the patients lesions ONC212 and showed interface dermatitis, vacuo-lar with atrophic epidermis, consistent with cutaneous lupus. There were also delicate foci of vascular damage, which raised the possibility of superimposed leukocytoclastic vasculitis. Bronchoalveolar lavage (BAL) confirmed suspicion of alveolar hemorrhage. BAL respiratory culture with gram stain grew 3000 colony-forming unit per mL of E.coli polyclonal to GST Tag.Posi Tag is a 45 kDa recombinant protein expressed in E.coli. It contains five different Tags as shown in the figure. It is bacterial lysate supplied in reducing SDS-PAGE loading buffer. It is intended for use as a positive control in western blot experiments PCR, and PCR. Serum herpes simplex types 1 and 2 was not detected. Table 1. Autoimmune workup. exposure remain unknown. Cyclophosphamide is currently pregnancy category X [3]. A study around the fetal effects of cyclophosphamide in mice was published in 2014 and showed a 6-fold increase of testicular malignancy compared to ONC212 the control group [12]. In addition, decreased spermatogenesis and ovarian follicle figures were observed in the intervention group [12]. Rituximab has also been used successfully in several case reports, but is not considered the standard of care. Supportive treatment with mechanical ventilation and blood transfusions should be considered if necessary. Plasmapheresis, which helps removes antigen-antibody complexes from your blood, may be used for refractory cases [1,5]. Whether plasmapheresis enhances survival is unknown [1]. There are only 7 case reports of DAH in pregnancy. Table 2 summarizes each case with the year the case was published, age of gestation, treatment modality, and end result of the pregnancy. In 4 of the 7 reported cases of DAH complicating SLE in pregnancy, the decision was made to terminate the pregnancy and then administer cyclophosphamide. One individual received azathioprine in the beginning, but with recurrence of DAH, IV cyclophosphamide was used. All 7 patients survived. Patients ages ranged from 23 to 38 years old, and gestation age ranged from 17 weeks to 35 weeks. Patients were diagnosed with SLE 13 years, 10 years, 6 years, and 1 month (2 cases) prior to their presentation of DAH. Two cases were diagnosed with SLE in the antepartum period. The first case involved a 38-year-old at 28 weeks gestation requiring emergent C-section due to fetal bradycardia. She was found to have DAH with hemoptysis seen on endotracheal tube during C-section, with radiologic findings and BAL confirming DAH. She was subsequently diagnosed with SLE with positive immunologic findings, lupus nephritis, antiphospholipid syndrome, lymphocytopenia, and thrombocytopenia [10,13C15]. Table 2. All cases of DAH in SLE during pregnancy. thead th valign=”middle” align=”center” rowspan=”1″ colspan=”1″ Author /th th valign=”middle” align=”center” rowspan=”1″ colspan=”1″ 12 months /th th valign=”middle” align=”center” rowspan=”1″ colspan=”1″ Age, yrs /th th valign=”middle” align=”center” rowspan=”1″ colspan=”1″ GA, wks /th th valign=”middle” align=”center” rowspan=”1″ colspan=”1″ Diagnosis, yrs /th th valign=”middle” align=”center” rowspan=”1″ colspan=”1″ SLE manifestations /th th valign=”middle” align=”center” rowspan=”1″ colspan=”1″ MV /th th valign=”middle” align=”center” rowspan=”1″ colspan=”1″ Termination /th th valign=”middle” align=”center” rowspan=”1″ colspan=”1″ Treatment /th th valign=”middle” align=”center” rowspan=”1″ colspan=”1″ Outcome (mother) /th /thead Blitz and Fleischer [1]20182317 (prima)17Heme, lupus nephritis, skinNoYesMP, CYC, PLEXSurvived br / Pregnancy terminated, at 17 wksNg et. al. [10]2017383238Skin, nephritis, hematologic,.