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SLE with pregnancy is a unique challenge for obstetricians as it poses significant maternal and foetal complications during pregnancy. Due to hormonal influence women with known case of SLE are more prone for lupus flare which affects mucocutaneous, musculoskeletal, and renal manifestation more frequently. CASE PRESENTATION: We present a case of successfully managed of newly diagnosed SLE in early pregnancy who developed lupus flare and lupus nephritis in early pregnancy. Patient had history of recurrent high grade of fever which were not responding to conservative treatment and subsequently developed skin rash and oral ulcers with constitutional symptoms like fatigue, joint pain. Multidisciplinary team care was started including nephrologist, dermatologist, rheumatologist and obstetrician. Required investigations were sent and counselling regarding maternal and foetal high risk, need for close follow-up, and need for strict adherence to continuation of therapy was done. Hydroxychloroquine, azathioprine, and prednisolone was started and tapered to lowest effective dose. Lupus flare and lupus nephritis managed successfully and patient remained in remission phase throughout pregnancy. She developed preeclampsia in later half of pregnancy and kept on antihypertensive. Continuous foetal monitoring with NTNB scan, early anomaly scan, foetal echo, foetal colour doppler and interval growth scan was done. She delivered healthy child of 2.9 kg at 37 weeks of gestation by elective lower segment caesarean section. She was advised to breastfeed and continue her immunosuppressive drugs in postpartum period. CONCLUSION: SLE with pregnancy is a high-risk pregnancy especially if patient has lupus flare, antiphospholipid antibodies, anti-Ro ana Anti-La antibodies are positive. These pregnancies should be handled and taken care of at Mult speciality clinic. Effect of pregnancy on SLE and vice versa, risk of congenital anomaly in foetus due to positive antinuclear antibodies and drugs used for management of lupus warrants proper counselling of couple for the need of multidisciplinary team care and close surveillance of mother and foetus throughout pregnancy and puerperium.