A 35-Year-Old Woman with Shortness of Breath and Edema in the Legs

This case discusses a 35-year-old woman who developed persistent leg edema and shortness of breath postpartum. Initially presumed to have preeclampsia, further evaluation revealed nephrotic-range proteinuria and hypoalbuminemia that persisted beyond delivery. Kidney biopsy confirmed primary focal segmental glomerulosclerosis (FSGS). The patient received high-dose prednisone with partial remission but later relapsed. Due to steroid dependence and side effects, she was treated with cyclophosphamide and rituximab, achieving long-term partial remission. This case highlights the diagnostic challenge in distinguishing preeclampsia from glomerular disease in pregnancy and the role of biopsy and immunosuppression in management.

This case discusses a 35-year-old woman who developed persistent leg edema and shortness of breath postpartum. Initially presumed to have preeclampsia, further evaluation revealed nephrotic-range proteinuria and hypoalbuminemia that persisted beyond delivery. Kidney biopsy confirmed primary focal segmental glomerulosclerosis (FSGS). The patient received high-dose prednisone with partial remission but later relapsed. Due to steroid dependence and side effects, she was treated with cyclophosphamide and rituximab, achieving long-term partial remission. This case highlights the diagnostic challenge in distinguishing preeclampsia from glomerular disease in pregnancy and the role of biopsy and immunosuppression in management.