Referral to someone who has a lot of experience in SLE - quick.

The severely active SLE would need to be treated aggressively. The dilated cardiomyopathy would need supportive and symptomatic care. Secondary causes for the dilated cardiomyopathy would need to be excluded before assuming it is due to the SLE. Is there any anti-phospholipid syndrome features? What are the other features of the active SLE? There are many factors to take into account. Close co-ordination between the rheumatology and cardiology teams will be necessary.

Assuming that there is no super-added infective process, and it is just the SLE you need to treat (a big assumption here), then IV methylprednislolone and/followed by IVIG (intravenous immunoglobulin) would be the initial options. I wish you all the best in treating her.

Severe SLE should be treated aggressively.  The activity can be treated with methylprednisolone I.V to be followed by immunosuppressive medications according to the organ affection. Dilated cardio myopia thy should be assessed carefully by cardiologist before consideration as part of SLE. 

Thanks a lot for all answers and I deeply appreciate your cooperation.

Dear Faiq,

In the case of severe SLE and pregnancy complications, I would suggest to think about extracorporeal treatment options, since both treatment options may have a beneficial effect without severe adverse events.

Best wishes

Andreas

Dilated cardio myopia thy should be assessed carefully by cardiologist before consideration as part of SLE. Asses complete SLE disease activity and think of  anti-phospholipid syndrome and infections.

Best wishes

Thanks a lot Andreas and Aleksandra for your answers

I request an emergency cardiology consult. In addition, I'll treat her lupus aggressively based on organ involvement with high dose glucocorticoid plus immunosuppressive medication. Moreover, antimalaria should not be forgot in her management.

Thanks a lot Alimohammad for your answer. Best regads