{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T07:10:01Z","timestamp":1756278601451,"version":"3.44.0"},"reference-count":12,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2016,9,19]]},"abstract":"<jats:p>A woman aged 22\u2005years with a history of lupus presented in the 18th week of pregnancy with hypertensive emergency and flash pulmonary oedema. Bedside echocardiogram revealed severe left ventricular (LV) dysfunction with an ejection fraction (EF) of 25% and pericardial effusion. Laboratories revealed hypocomplementemia, proteinuria, elevated C reactive protein and anti-DS-DNA, raising concern for a lupus flare. Cardiac MRI showed an acute intramyocardial oedematous process, consistent with lupus carditis, and further worsening of LVEF to 13%. Shared-decision-making with the patient included discussion of maternal risks of continuation of pregnancy in the setting of worsening heart function and the fetal risks of definitive treatment with cyclophosphamide for a lupus flare and the patient decided to proceed with medical termination of pregnancy. Treatment with immunosuppressants, including cyclophosphamide, and steroids, was then initiated. 2 months after discharge, cardiac MRI showed marked improvement in LVEF to 50% and the patient remains clinically free of heart failure.<\/jats:p>","DOI":"10.1136\/bcr-2016-216385","type":"journal-article","created":{"date-parts":[[2016,10,4]],"date-time":"2016-10-04T11:21:07Z","timestamp":1475580067000},"page":"bcr2016216385","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Triple threat in pregnancy"],"prefix":"10.1136","volume":"2016","author":[{"given":"Swati","family":"Vishwanathan","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Lucke","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Indu G","family":"Poornima","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2016,10,4]]},"reference":[{"key":"2025082623473056000_2016.oct04_1.bcr2016216385.1","doi-asserted-by":"publisher","DOI":"10.1385\/CRIAI:29:3:219"},{"key":"2025082623473056000_2016.oct04_1.bcr2016216385.2","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2006.058784"},{"key":"2025082623473056000_2016.oct04_1.bcr2016216385.3","doi-asserted-by":"publisher","DOI":"10.1002\/art.10461"},{"key":"2025082623473056000_2016.oct04_1.bcr2016216385.4","doi-asserted-by":"publisher","DOI":"10.4065\/74.3.275"},{"key":"2025082623473056000_2016.oct04_1.bcr2016216385.5","doi-asserted-by":"publisher","DOI":"10.1191\/0961203305lu2200oa"},{"key":"2025082623473056000_2016.oct04_1.bcr2016216385.6","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(02)01223-8"},{"key":"2025082623473056000_2016.oct04_1.bcr2016216385.7","doi-asserted-by":"publisher","DOI":"10.1177\/0961203310395800"},{"key":"2025082623473056000_2016.oct04_1.bcr2016216385.8","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kem371"},{"key":"2025082623473056000_2016.oct04_1.bcr2016216385.9","doi-asserted-by":"crossref","first-page":"1538","DOI":"10.1002\/art.1780341210","article-title":"Frequency of lupus flare in pregnancy. The Hopkins Lupus Pregnancy Centre experience","volume":"34","author":"Petri","year":"1991","journal-title":"Arthritis Rheum"},{"key":"2025082623473056000_2016.oct04_1.bcr2016216385.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2008.03.012"},{"key":"2025082623473056000_2016.oct04_1.bcr2016216385.11","doi-asserted-by":"publisher","DOI":"10.7326\/M14-2235"},{"key":"2025082623473056000_2016.oct04_1.bcr2016216385.12","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780381203"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2016-216385","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T06:47:38Z","timestamp":1756277258000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2016-216385"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,10,4]]},"references-count":12,"alternative-id":["10.1136\/bcr-2016-216385"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2016-216385","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2016,10,4]]}}}