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Daher A, Sauvetre G, Girszyn N, Verspyck E, Levesque H, Le Besnerais M. Granulomatosis with polyangiitis and pregnancy: A case report and review of the literature. Obstet Med 2020; 13:76-82. [PMID: 32714439 PMCID: PMC7359661 DOI: 10.1177/1753495x18822581] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 12/10/2018] [Indexed: 12/24/2022] Open
Abstract
The association of granulomatosis with polyangiitis and pregnancy is rare and therapeutic options are limited by the risk of teratogenicity and fetotoxicity. There is a paucity of published literature to guide clinical decision-making in these cases. We report the case of a 26-year-old woman with no medical history who presented at 21 weeks of gestation with a bilateral sudden loss of hearing and erosive rhinitis. The diagnosis of granulomatosis with polyangiitis was confirmed radiologically and biologically. Corticosteroids were not enough to stabilize the disease and she received intravenous immunoglobulins with remission. A successful delivery of a healthy male newborn was done at 36 weeks. A review of all published literature on granulomatosis with polyangiitis in pregnancy between 1970 and 2017 is presented. Trial registration: Not applicable.
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Affiliation(s)
- A Daher
- Internal Medicine Department, CHU de Rouen, Rouen, France
| | - G Sauvetre
- Internal Medicine Department, CHU de Rouen, Rouen, France
| | - N Girszyn
- Internal Medicine Department, CHU de Rouen, Rouen, France
| | - E Verspyck
- Obstetric and Gynecology Department, CHU de Rouen, Rouen, France
| | - H Levesque
- Internal Medicine Department, CHU de Rouen, Rouen, France
| | - M Le Besnerais
- Internal Medicine Department, CHU de Rouen, Rouen, France
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Singh P, Dhooria A, Rathi M, Agarwal R, Sharma K, Dhir V, Nada R, Minz R, Suri V, Jain S, Sharma A. Successful treatment outcomes in pregnant patients with ANCA-associated vasculitides: A systematic review of literature. Int J Rheum Dis 2019; 21:1734-1740. [PMID: 30345645 DOI: 10.1111/1756-185x.13342] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM Antineutrophil cytoplasmic antibody-associated vasculitides (AAV) are a group of small vessel vasculitis with systemic presentations and considerable morbidity and mortality. Pregnancy in these patients poses a significant therapeutic challenge. There is limited published literature regarding pregnancy in AAV. METHODS Two cases of successful pregnancy outcomes in patients with active AAV are described. A systematic review was conducted on the lines of the PRISMA statement for conducting systemic reviews: PubMed (inception of PubMed until 30 April 2017, English language only) and EmBase databases were searched using the following terms: 'pregnancy' AND 'ANCA associated vasculitis' OR 'granulomatosis with polyangiitis' OR 'eosinophilic granulomatosis with polyangiitis' OR 'microscopic polyangiitis' OR 'Churg-Strauss syndrome' OR 'Wegener's granulomatosis'. RESULTS One hundred and thirty-seven pregnancies were documented in 110 patients of AAV. Vasculitis diagnosis was made before pregnancy in 69, during pregnancy in 32 and after pregnancy in 9 patients. Mean age at the time of pregnancy was 29.3 ± 5.3 years. There were 91 term pregnancies, 28 were preterm pregnancies, 15 abortions and 3 still births; 78 had normal delivery and 26 had caesarian section. CONCLUSION Successful pregnancies have been reported in AAV patients.
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Affiliation(s)
- Pawan Singh
- Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Aadhaar Dhooria
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manish Rathi
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kusum Sharma
- Department of Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Varun Dhir
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritambhra Nada
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ranjana Minz
- Department of Immunopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vanita Suri
- Department of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sanjay Jain
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Aman Sharma
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Veltri NL, Hladunewich M, Bhasin A, Garland J, Thomson B. De novo antineutrophil cytoplasmic antibody-associated vasculitis in pregnancy: a systematic review on maternal, pregnancy and fetal outcomes. Clin Kidney J 2018; 11:659-666. [PMID: 30288261 PMCID: PMC6165750 DOI: 10.1093/ckj/sfy011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 01/23/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND De novo antineutrophil cytoplasmic antibody-associated vasculitis typically arises in post-reproductive years, but can occur during pregnancy. Concerns of treatment-related teratogenicity persist, while efficacy and safety of new therapies including intravenous immunoglobulin (IVIG) and rituximab are uncertain. There remains a paucity of maternal, fetal and pregnancy outcome data in these women, and therefore a lack of guidance on safe treatment for clinicians. METHODS We conducted a systematic review of the literature and a local, retrospective chart review of women with de novo antibody-associated vasculitis (AAV) in pregnancy. Cochrane, Embase and PubMed databases and relevant conference abstracts were searched. Patient demographics, clinical presentation, management and outcomes (maternal, fetal and pregnancy-related) were analyzed. RESULTS Twenty-seven cases of de novo AAV in pregnancy were included. Women presented were from 5 to 39 weeks' gestation, of which a majority were in the second trimester (median 20 weeks). The median gravida of women was 2 and the median parity was 1. Women were treated with steroids (89%), cyclophosphamide (CYC) (37%), other immunosuppressive agents [azathioprine (AZA), IVIG, plasma exchange (PLEX)] or no therapy (11%). High rates of serious complications, including preeclampsia (29%) and maternal death (7%), were reported; however, most pregnancies resulted in live birth (73%). Prematurity was common; 73% of live births occurred prior to 37 weeks' gestation and 40% prior to 34 weeks' gestation. The majority of infants were born in the third trimester (median 34.5 weeks). Rates of pregnancy termination were high (23%) and only one intrauterine death was reported, shortly after initiation of therapy (4%). Congenital abnormalities were rare, with one infant having a solitary, pelvic kidney (6%) after maternal treatment with steroids, CYC and PLEX. Use of PLEX, IVIG and AZA increased after 2005, whereas CYC use decreased. Remission often occurred postpartum (60%). CONCLUSIONS De novo AAV in pregnancy can result in uncomplicated pregnancies; however, serious maternal risks exist. Further data on potentially pregnancy compatible therapies such as IVIG and rituximab are needed in this population.
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Affiliation(s)
- Nicole L Veltri
- Division of Internal Medicine, Department of Medicine, Queen’s University, Kingston, ON, Canada
| | - Michelle Hladunewich
- Division of Nephrology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Arrti Bhasin
- Division of Nephrology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jocelyn Garland
- Division of Nephrology, Department of Medicine, Queen’s University, Kingston, ON, Canada
| | - Benjamin Thomson
- Division of Nephrology, Department of Medicine, Queen’s University, Kingston, ON, Canada
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Pefanis A, Williams DS, Skrzypek H, Fung A, Paizis K. A case of ANCA-associated vasculitis presenting de novo in pregnancy, successfully treated with rituximab. Obstet Med 2018; 13:41-44. [PMID: 32284732 DOI: 10.1177/1753495x18780853] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 04/26/2018] [Indexed: 12/16/2022] Open
Abstract
Antineutrophil cytoplasm antibody (ANCA)-associated vasculitides are rare small vessel vasculitides of unknown cause. The pathogenic role of MPO-ANCA in the vasculitides has been supported using various animal models, with B-cells playing a role in the disease pathogenesis. Pregnancy in the presence of an autoimmune disease such as vasculitis is often associated with significant morbidity. Little is known about the outcomes when women present with de novo vasculitis during pregnancy, and the appropriate management of such presentations is unclear. We describe a case of a 33-year-old female presenting in her second pregnancy with new onset ANCA vasculitis at 12 weeks' gestation. She was successfully treated with prednisolone and rituximab, and delivered a healthy 2.8 kg boy at 36 weeks' gestation with no clinical manifestations of vasculitis or neutropenia in the neonate.
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Affiliation(s)
- A Pefanis
- Department of Nephrology, Austin Health, Melbourne, Australia
| | - D S Williams
- Department of Nephrology, Austin Health, Melbourne, Australia
| | - H Skrzypek
- Department of Obstetric, Medicine, Mercy Health, Melbourne, Australia
| | - A Fung
- Department of Obstetric, Medicine, Mercy Health, Melbourne, Australia
| | - K Paizis
- Department of Nephrology, Austin Health, Melbourne, Australia.,Department of Obstetric, Medicine, Mercy Health, Melbourne, Australia
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Saxby AJ, Pace-Asciak P, Dar Santos RC, Chadha NK, Kozak FK. The rhinological manifestations of women's health. Otolaryngol Head Neck Surg 2013; 148:717-31. [PMID: 23426708 DOI: 10.1177/0194599813477837] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To systematically review the literature and appraise the evidence reporting the effects of women's health, including pregnancy, postpartum, menstruation, oral contraception, menopause, and hormone replacement therapy, on common rhinological pathologies and nasal physiology. DATA SOURCES Systematic search strategy using MEDLINE (1966-2012) and EMBASE (1980-2012) databases. REVIEW METHODS Title review, abstract screening, and then full paper analysis were undertaken by 2 authors independently. Level of evidence was graded according to the Oxford Centre of Evidence Based Medicine 2011 criteria and risk of bias assessment using the Jadad scale for randomized controlled trials and Newcastle-Ottawa Scale for cohort and case-controlled studies. RESULTS Over the 46 years analyzed, the search strategy produced 2904 titles. In total, 314 abstracts were screened, from which 192 full-text articles were evaluated, and 145 research papers met all the criteria for inclusion in the study. Overall, the available evidence was of low quality. Seventy percent of studies (102 of 145) were case reports or case series from which only limited conclusions can be drawn. Only 3% of the included papers (4 of 145) were randomized controlled studies. The remaining data were mainly of a prospective cohort design. Study heterogeneity in design and measured outcomes resulted in data synthesis being limited to a descriptive/exploratory review. Study findings are presented by women's health category and then by rhinological manifestation with important clinical correlations highlighted. CONCLUSION Physiological and hormonal changes occurring as a normal part of women's health have an important influence on rhinological function and disease.
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Affiliation(s)
- Alexander J Saxby
- Division of Otolaryngology, Head and Neck Surgery, Children's and Women's Hospital, Vancouver, BC, Canada.
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7
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Gatto M, Iaccarino L, Canova M, Zen M, Nalotto L, Ramonda R, Punzi L, Doria A. Pregnancy and vasculitis: A systematic review of the literature. Autoimmun Rev 2012; 11:A447-59. [DOI: 10.1016/j.autrev.2011.11.019] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Abstract
Pregnancy may affect the diagnosis, management, and outcome of infiltrative lung disease (ILD). Conversely, ILD may affect pregnancy. ILD may occur as a result of drugs administered commonly or specifically during pregnancy. Most ILDs predominate in patients older than 40 years and are thus rare in pregnant women. During pregnancy ILD may arise de novo and preexisting ILD may be exacerbated or significantly worsened. Some ILDs generally do not alter the management of pregnancy, labor, or delivery. Preexisting ILD no longer contraindicates pregnancy systematically, but thorough evaluation of ILD before pregnancy is required to identify potential contraindications and adapt monitoring.
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Affiliation(s)
- N Freymond
- Department of Respiratory Medicine, Reference Centre for Rare Pulmonary Diseases, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France; University of Lyon I, UMR754 INRA, IFR 128, Lyon, France
| | - V Cottin
- Department of Respiratory Medicine, Reference Centre for Rare Pulmonary Diseases, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France; University of Lyon I, UMR754 INRA, IFR 128, Lyon, France
| | - J F Cordier
- Department of Respiratory Medicine, Reference Centre for Rare Pulmonary Diseases, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France; University of Lyon I, UMR754 INRA, IFR 128, Lyon, France.
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Devakumar VN, Castelino M, Chow SC, Teh LS. Wegener's granulomatosis in pregnancy: a case report and review of the medical literature. BMJ Case Rep 2010; 2010:bcr09.2009.2296. [PMID: 22242076 PMCID: PMC3029874 DOI: 10.1136/bcr.09.2009.2296] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A Caucasian woman in the third trimester of her sixth pregnancy was diagnosed with Wegener's granulomatosis (WG) following investigation for recurrent ear infections and a persistent dry cough. Chest radiograph showed granulomatous lesions and the c-ANCA (antineutrophil cytoplasmic antibody) was strongly positive. She required pulsed methylprednisolone and cyclophosphamide followed by oral prednisolone and azathioprine to control the disease process during and after pregnancy. Neither the disease nor aggressive treatment adversely affected the pregnancy and she delivered a healthy baby girl by elective induction at 37 weeks. A review of the literature on Wegener's granulomatosis in pregnancy is presented.
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Affiliation(s)
- Vinodh Nanjanna Devakumar
- The Royal Oldham Hospital, Rheumatology and Medicine, K Block, Rochdale Road, Oldham, OL1 2JH, UK
- Kendal Drive, Gatley, Cheadle, Cheshire SK84QJ, UK
| | - Madhura Castelino
- Royal Blackburn Hospital, Rheumatology, Rheumatology Department, Blackburn BB2 3HH, UK
| | - Shien-Ching Chow
- Royal Blackburn Hospital, Department of Rheumatology, Haslingden Road, Blackburn BB2 3HH, UK
| | - Lee-Suan Teh
- Royal Blackburn Hospital, Department of Rheumatology, Haslingden Road, Blackburn BB2 3HH, UK
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10
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Spencer CP, Partington CK, Soon R, Weston MJ, Makanjuola D. Pregnancy complicated by Wegener's granulomatosis. J OBSTET GYNAECOL 2009. [DOI: 10.3109/01443619509009168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Soh MC, Hart HH, Bass E, Wilkinson L. Pregnancy complicating Wegener's granulomatosis. Obstet Med 2009; 2:77-80. [PMID: 27582817 PMCID: PMC4989724 DOI: 10.1258/om.2009.080053] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2009] [Indexed: 11/18/2022] Open
Abstract
Pregnancy associated with Wegener's granulomatosis is rare. Therapeutic options are limited. There is a paucity of published literature to guide clinical decision-making in these complex patients. Two cases are presented. Firstly, a 33-year-old woman with generalized Wegener's in remission and off all medications presented with a flare in the third trimester with haemoptysis, raised C-reactive protein and c-anti-neutrophilic cytoplasmic antibody (c-ANCA) levels. Her care was complicated by florid steroid-induced psychosis. With deteriorating disease control, she was treated with pulsed-intravenous cyclophosphamide with a good response. She delivered a healthy baby at 38 weeks. She had a severe postpartum flare. Secondly, a 37-year-old woman with limited Wegener's in remission for the last two years and off all treatment became pregnant after pre-conception counselling. A normal baby was delivered at term. An exhaustive review of all published literature on Wegener's activity in pregnancy is presented along with therapeutic options and recommendations.
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Affiliation(s)
- May Ching Soh
- North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
| | - Hamish H Hart
- North Shore Hospital, North Shore City, Auckland, New Zealand
| | - Eileen Bass
- National Women's Health, Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Lucille Wilkinson
- National Women's Health, Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand
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Abstract
Until recently, the prognosis associated with many forms of systemic vasculitis was quite grim. Advances in this field have allowed us to begin to focus on issues related to quality of life such as fertility, conception, and pregnancy among women with vasculitis. Because the systemic vasculitides are rare diagnoses, many important questions remain unanswered. Overall, it seems that women who have inactive vasculitis may not be subject to unusual complications during pregnancy, but our understanding of the interaction between pregnancy and specific forms of vasculitis continues to evolve.
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Affiliation(s)
- Philip Seo
- The Johns Hopkins University, Division of Rheumatology, Baltimore, MD 21224, USA.
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Koukoura O, Mantas N, Linardakis H, Hajiioannou J, Sifakis S. Successful term pregnancy in a patient with Wegener's granulomatosis: case report and literature review. Fertil Steril 2007; 89:457.e1-5. [PMID: 17517407 DOI: 10.1016/j.fertnstert.2007.03.054] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2006] [Revised: 03/19/2007] [Accepted: 03/19/2007] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To present a case of successful term pregnancy in a patient with known Wegener's granulomatosis (WG). DESIGN Case report. SETTING University Hospital, Department of Obstetrics and Gynecology. PATIENT(S) A 22-year-old primigravida pregnant woman with a history of WG diagnosed 5 years before. INTERVENTION(S) The patient was treated with corticosteroids and azathioprine throughout pregnancy, and cyclophosphamide was added postpartum. MAIN OUTCOME MEASURE(S) The disease was in partial remission at the onset of pregnancy, but two relapses occurred, at 33 weeks' gestation and 15 days after delivery. A 3150-g healthy boy was delivered at 37 weeks' gestation. CONCLUSION(S) Pregnancy in patients with WG requires preconceptional planning, careful clinical management, and vigorous treatment of active disease. There are 36 cases of WG in pregnancy reported in the literature. Owing to this rarity, the management is individualized and the pregnancy outcome is variable. Antenatal management and therapeutic options are discussed and a short review of the literature is presented.
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Affiliation(s)
- Ourania Koukoura
- Department of Obstetrics-Gynecology, University Hospital of Heraklion, Crete, Greece
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Mubashir E, Ahmed MM, Hayat S, Latif S, Heldmann M, Berney SM. Wegener Granulomatosis: A Case Report and Update. South Med J 2006; 99:977-88. [PMID: 17004532 DOI: 10.1097/01.smj.0000232210.04881.d3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Wegener granulomatosis (WG) is a systemic disease of unknown etiology characterized by necrotizing granulomatous inflammation, tissue necrosis, and variable degrees of vasculitis in small and medium-sized blood vessels. The classic clinical pattern is a triad involving the upper airways, lungs and kidneys. Ninety percent of patients present with symptoms involving the upper and/or lower airways, and 80% will eventually develop renal disease. WG should be suspected in any patient with progressive or unresponsive sinus disease, glomerulonephritis, pulmonary hemorrhage, mononeuritis multiplex or unexplained multisystem disease. Before the routine use of glucocorticoids and cyclophosphamide, the one year mortality was 82%. However in 1973, Fauci and Wolf discovered that daily prednisone and cyclophosphamide induced complete remission in 75% of patients. The continued use of prednisone and cyclophosphamide for 1 year past remission leads to marked improvement in more than 90% of patients; however, is also associated with serious toxicities. Depending on the disease severity, current treatments employ induction with short-term cyclophosphamide followed by less toxic agents such as methotrexate to maintain disease remission. Although it is a rare disorder, it is pertinent to internists because it is a multisystem disease that presents in a variety of ways. We describe a 63-year-old white male with WG who presented with progressively worsening headaches, bilateral eye redness, epistaxis, hemoptysis and an unintentional 20 pound weight loss, and review the current treatment recommendations.
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Affiliation(s)
- Eisha Mubashir
- Center of Excellence for Arthritis and Rheumatology, Section of Rheumatology, Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA, USA
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Woywodt A, de Groot K, Bahte S, Schwarz A, Haller H, Haubitz M. Severe relapse of Wegener's granulomatosis during the early postpartum period. Ann Rheum Dis 2006; 65:137. [PMID: 16344503 PMCID: PMC1797990 DOI: 10.1136/ard.2005.037598] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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17
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Bessias N, Moulakakis KG, Lioupis C, Bakogiannis K, Sfyroeras G, Kakaletri K, Andrikopoulos V. Wegener's granulomatosis presenting during pregnancy with acute limb ischemia. J Vasc Surg 2005; 42:800-4. [PMID: 16242573 DOI: 10.1016/j.jvs.2005.05.038] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2005] [Accepted: 05/18/2005] [Indexed: 11/27/2022]
Abstract
We report a rare case of a pregnant woman with Wegener's granulomatosis whose disease involved the lungs, the spleen, and a limb. Wegener's granulomatosis was clinically manifested in the 34th week of pregnancy with pulmonary infiltrates, splenic infarcts, and acute limb ischemia. Successive thrombectomies failed to maintain arterial flow in the distal limb due to the development of active vasculitis. Thrombosis of the tibial arteries and recurrence of thrombosis was a persistent clinical observation. In the meantime, a cesarean section was performed, with a successful delivery of a healthy male newborn. Because of the recent cesarean section, the patient did not undergo thrombolysis. The woman finally underwent amputation of the limb. According to the reviewed literature, this is the sixth reported case of Wegener's granulomatosis presenting with digital ischemia and the first manifested during pregnancy.
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Affiliation(s)
- Nikolaos Bessias
- Department of Vascular Surgery, Red Cross Hospital, Athens, Greece
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18
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Auzary C, Huong DT, Wechsler B, Vauthier-Brouzes D, Piette JC. Pregnancy in patients with Wegener's granulomatosis: report of five cases in three women. Ann Rheum Dis 2000; 59:800-4. [PMID: 11005781 PMCID: PMC1752998 DOI: 10.1136/ard.59.10.800] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Five cases of pregnancy occurring in three women with previously diagnosed Wegener's granulomatosis are described. The disease was diffuse in one case and localised in the other. Initial treatment consisted of a combination of corticosteroids and intravenous cyclophosphamide in two women, and methotrexate in one. Four pregnancies ended in live births despite pre-eclampsia in two cases. One therapeutic abortion was induced because of encephalocele. Comparable reported cases were reviewed to examine the implications of immunosuppressive treatment on the fetus. A relapse occurred during pregnancy in 40% of the cases, but in 25% if only pregnancies beginning during inactive disease were taken into account. No other indicator for maternal and fetal outcome was obvious. Pregnancy should be planned after complete disappearance of disease activity. In the case of a relapse a combination of immunosuppressive drugs and corticosteroids should be chosen rather than corticosteroids alone because the outcome of pregnancy is poor in cases of undertreatment. Prematurity remains common.
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Affiliation(s)
- C Auzary
- Department of Internal Medicine, Hôpital de Bicêtre, 78 avenue du general leclerc, 94270 Le Kremlin-Bicetre, France
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19
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Dayoan ES, Dimen LL, Boylen CT. Successful treatment of Wegener's granulomatosis during pregnancy: a case report and review of the medical literature. Chest 1998; 113:836-8. [PMID: 9515867 DOI: 10.1378/chest.113.3.836] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
During the 18th week of a first pregnancy, a 20-year-old woman visits her physician complaining of cough, sore throat, and hemoptysis of 4 days in duration. A chest radiograph, laboratory study findings including a cytoplasmic antineutrophil cytoplasmic autoantibody titer, and lung biopsy results were consistent with a limited form of Wegener's granulomatosis. She was treated successfully with prednisone and cyclophosphamide. The remainder of her pregnancy was otherwise uneventful and resulted in a normal labor and delivery of a healthy male infant.
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Affiliation(s)
- E S Dayoan
- Department of Pulmonary and Critical Care Medicine, University of Southern California Medical Center, Los Angeles 90033, USA
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20
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Abstract
This report describes a case of severe limited Wegener's granulomatosis (WG) presenting in the third trimester of pregnancy with pansinusitis and necrotizing pneumonitis. The patient was treated successfully with a combination of corticosteroids and cyclophosphamide (CYC). The outcomes in the mother and the newborn were excellent. In a review of the English-language literature, we found 10 similar cases of WG with 13 pregnancies. WG occurring during pregnancy may have a more aggressive course and may require more aggressive treatment compared with WG occurring at other times. The treatment options for WG in pregnancy are discussed.
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Affiliation(s)
- P Luisiri
- University of Chicago, Illinois 60637, USA
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22
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PREGNANCY LOSS IN AUTOIMMUNE DISEASES. Immunol Allergy Clin North Am 1994. [DOI: 10.1016/s0889-8561(22)00344-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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23
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M'Rad S, Moalla M, Ben Miled K, Falfoul A, Grossin M, Ben Jilani S, Hamza M, Ben Dridi M, Ben Ayed H. [Wegener's granulomatosis and pregnancy. A case]. Rev Med Interne 1989; 10:69-72. [PMID: 2655053 DOI: 10.1016/s0248-8663(89)80121-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Pregnancy concomitant with Wegener's granulomatosis is extremely rare: so far, only four cases have been published. The authors report a fifth case where the disease appeared during the post-partum period, a situation which has already been noted in two of the published cases. Interruption of a subsequent pregnancy was followed by a flare-up of the disease resulting in the patient's death. This suggests that post-partum and post-abortum are probably instrumental in the onset and deterioration of Wegener's granulomatosis. The two patients previously reported who received immunosuppressants combined with corticosteroids had no flare-up after delivery. It seems permissible to prescribe such a therapeutic combination before and after delivery or abortion, especially since the fear of foetal toxicity from these drugs seems to be exaggerated.
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Affiliation(s)
- S M'Rad
- Service de médecine interne, CHU La Marsa, Tunisie
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