A rare case of acute onset vasculitis in pregnancy

Vasculitis in pregnancy is a rare condition. When a patient presents, it is usually a pregnant woman with a previous diagnosis of vasculitis. We present a case of vasculitis presenting for the first time during pregnancy with a remarkable recovery following the delivery. A 32 year old, previously healthy primi gravida presented at a gestation of 28 weeks and four days with a history of fever for three days. She developed a vasculitic type rash over both lower limbs. Investigations revealed urinary sediments, proteinuria, haematuria, and pulmonary consolidation, suggesting skin, renal and pulmonary involvement. Patient did not improve despite adequate treatment with antibiotics and antiviral treatment. Not only the investigations done to identify a possible aetiology leading to a secondary vasculitis but also the tests done to classify a primary vasculitis, became negative. Skin biopsy suggested leucocytoclastic small vessel vasculitis. Patient symptomatically improved with methylprednisolone pulse therapy and plasmapheresis. Termination of pregnancy was considered with a view of commencing cytotoxic therapy to prevent permanent pulmonary and renal injury. On day 18th of the illness, live baby was delivered by Caesarean section at a gestation of 31 weeks. Patient improved dramatically following the delivery. Patient became completely asymptomatic over few days, proteinuria and pulmonary fibrosis reversed in about one months’ time with steroids.