Fate of a Pregnant Women with Mixed Connective Tissue Disease in a Tertiary Care Hospital in India - A Case Report

Abstract

Mixed connective tissue disease (MCTD) is a term involving the features of lupus systemic sclerosis, polymyositis, rheumatoid arthritis and high titre of anti ribonucleoprotein (RNP) antibodies however the exact etiology of the disease is not known. MCTD is characterized by microvascular damage, along with activation of the immune system leading to inflammation and excessive deposition of collagen in the skin, lungs, heart, gastrointestinal tract and kidneys. The females are more affected, especially after childbirth may be because of the hypothesis of microchimerism. The pathogenesis being a two way migration of fetal cells through the placenta. Although it cannot be cured completely but treatment with corticosteroids is helpful. The complications were preeclampsia, preterm labor, fetal growth restriction, eclampsia, thrombocytopenia and infections like pneumonia, sepsis like syndrome. The maternal mortality rate is approximately around 325/100000. We encountered a similar case of mixed connective tissue disorder in a patient aged 24 years at 29 weeks of gestation. The patient had conceived spontaneously after 5 yrs of diagnosis and had presented with all the known complications of the disease including lung fibrosis, FGR, preeclampsia and ascites. However she delivered and thereafter stabilized, although her baby had to be treated for a prolonged period at the NICU.