Successful use of tadalafil in oligohydramnios associated with lupus pregnancy.

, We present the case of a 26-year-old female patient, who came to us with complaints of generalized swelling in the legs and a malar rash on her face, during the 17 th week of gestation. The patient’s complaints had begun only 1 month before prior to which she was fine. On general examination mild pallor and pedal edema were observed. The initial vital state was stable. Investigation showed mild anemia with a hemoglobin level of 7.4 mg/ dl. Initial investigations are presented in Table I. Serum albumin levels were low (2.5 g/dl) and urine examination showed presence of proteinuria. 24-hour urine protein estimation was 8 g/day. Other significant results: ANA positivity (1 : 2560, homogenous) and raised anti-dsDNA levels (450 IU/ml) as well as positive direct Coombs test. The ENA was positive for anti-Sm, anti-SSA and anti-SSB antibodies and C3 (31 mg/dl) and C4 levels (8 mg/dl) were also low, suggestive of lupus flare. Echocardiography showed mild pericardial effusion. The patient was diagnosed with lupus nephritis with autoimmune hemolytic anemia and serositis. Ultra-sound abdomen assessment done at baseline showed a normal healthy fetus appropriate for gestational age