Successful Pregnancy in a Churg-Strauss Syndrome Patient with a History of Intrauterine Fetal Death

Ogasawara, Mayumi; Kajiura, Shoji; Inagaki, Hiroko; Sasa, H.; Aoki, Kanae; Yagami, Y.

doi:10.1159/000237140

Cited by 23 publications

(17 citation statements)

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“…Sixteen participants had 2 pregnancies, 4 had 3 pregnancies and one had 4 pregnancies. The diagnosis was GPA in 78 patients, EGPA in 22 patients, MPA in 9 patients and renal vasculitis in one patient. Data regarding remission were available for 35 pregnancies in 34 patients with median duration of remission prior to pregnancy of 36 months (range, 3‐120 months) (Table ).…”

Section: Resultsmentioning

confidence: 99%

Successful treatment outcomes in pregnant patients with ANCA‐associated vasculitides: A systematic review of literature

et al. 2018

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Section: Resultsmentioning

confidence: 99%

Successful treatment outcomes in pregnant patients with ANCA‐associated vasculitides: A systematic review of literature

et al. 2018

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“…Eosinophils may be dampened during pregnancy because the cost of lowering protection against hookworm infection is outweighed by the danger of harming the fetus with “friendly fire” from the maternal immune system. Eosinophilia (eosinophil counts greater than 500 cells/uL) is not a feature of healthy pregnancy and appears to be associated with a higher risk of miscarriage and preterm birth (Lorraine, ; Ogasawara et al, ; Romero et al, ). Despite their high eosinophil counts relative to industrialized populations, Tsimane women experience rates of second‐ or third‐term miscarriage similar to other documented populations (Gurven, ) and high total fertility, indicating that Tsimane women successfully navigate the immune trade‐offs of a parasite‐endemic environment during pregnancy.…”

Section: Discussionmentioning

confidence: 99%

Old friends and friendly fire: Pregnancy, hookworm infection, and anemia among tropical horticulturalists

Anderson

Trumble

Hové

et al. 2019

American J Hum Biol

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Objectives Despite public health concerns about hookworm infection in pregnancy, little is known about immune profiles associated with hookworm (Necator americanus and Ancylostoma duodenale) infection during pregnancy. Fetal tolerance requirements may constrain maternal immune response to hookworm, thereby increasing susceptibility to new infections or increasing hemoglobin loss. To explore this possibility, we study systemic immune response and hemoglobin levels in a natural fertility population with endemic helminthic infection. Methods We used Bayesian multilevel models to analyze mixed longitudinal data on hemoglobin, hookworm infection, reproductive state, eosinophils, and erythrocyte sedimentation rate (ESR) to examine the effects of pregnancy and hookworm infection on nonspecific inflammation, cellular parasite response, and hemoglobin among 612 Tsimane women aged 15‐45 (1016 observations). Results Pregnancy is associated with lower eosinophil counts and lower eosinophil response to hookworm, particularly during the second and third trimesters. Both hookworm and pregnancy are associated with higher ESR, with evidence for an interaction between the two causing further increases in the first trimester. Pregnancy is moderately associated with higher odds of hookworm infection (OR: 1.23, 95% CI: 0.83 to 1.83). Pregnancy and hookworm both decrease hemoglobin and may interact to accentuate this effect in the first‐trimester of pregnancy (Interaction: β: −0.30 g/dL; CI: −0.870 to 0.24). Conclusions Our findings are consistent with a possible trade‐off between hookworm immunity and successful pregnancy, and with the suggestion that hookworm and pregnancy may have synergistic effects, particularly in the first trimester.

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“…Churg‐Strauss syndrome is rare and rarer still in pregnancy. The seven published case reports 3–9 indicate that, in common with other auto‐immune mediated conditions, the outcome is extremely variable, ranging from clinical improvement in one case to maternal death in two (both from cardiomyopathy) 3,8 . Careful medical management and, if possible, preconceptual planning, is therefore recommended 5 .…”

Section: Discussionmentioning

confidence: 99%

Churg‐Strauss disease: deterioration in a twin pregnancy. Successful outcome following treatment with corticosteroids and cyclophosphamide

Barry

Davis

Garrard

et al. 1997

BJOG

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A 25 year old woman, 23 weeks into a twin pregnancy, was admitted to the labour ward with hypertension and proteinuria. She had been taking phenytoin as anticonvulsant prophylaxis since the age of 16 but had been free of any fit and otherwise in good health until eight months earlier, when she began to notice symptoms of asthma. Control had proved difficult, requiring three hospital admissions, though ventilatory assistance had not been needed. During the most recent admission eight weeks earlier a chest X-ray had demonstrated widespread alveolar infiltrates and spirometry a restrictive deficit (FEV, of 1.4 and FVC of 1.7) with a peak flow of 250 L/min. She had also complained of dysaesthetic pain in both feet, and nerve conduction studies had shown changes of mild to moderate peripheral neuropathy. Some weeks later a vasculitic rash appeared at the extremities. Full blood counts showed an increasing eosinophilia count of up to 35%.A diagnosis of Churg-Strauss syndrome was made, and she was maintained on prednisolone (40 mg) once daily with inhaled bronchodilators, but continued to deteriorate, developing mononeuropathies of both hands. A week before admission she began to have persistent hypertension and proteinuria.On admission the blood pressure was 160/100 mmHg, and the JVP visible at 2 cm. There was mild ankle oedema. Coarse crackles were audible throughout both lung fields. A confluent purpuric rash was present over the dorsal aspects of both feet and ankles. Both feet were dysaesthetic, with marked contact hypersensitivity, and ankle dorsiflexion was weak (MRC grade 4).There were signs of left ulnar and right median nerve palsies. High doses of nifedipine and methyldopa were required to bring her blood pressure down to 140/90 mmHg. Azathioprine was added as a steroidsparing measure, and weekly dexamethasone injections administered in anticipation of preterm delivery. Satisfactory blood pressure control and reduction in proteinuria were achieved over the following three weeks, but her weakness and neuropathic pain continued to progress. Pulsed intravenous cyclophosphamide was started in a regime of 1 g/m2 with 0.6 mg of mesna (in divided doses) at monthly intervals, which was followed after two weeks by improved pain control and discharge home. No further progression of the mononeuropathies was observed at follow up two months later.She was readmitted at 30 weeks with preterm prelabour rupture of the membranes, and induction of labour was started that day, with an oxytocin infusion. After three hours she underwent an emergency caesarean section for a compound presentation of the first twin. Two female infants were born with birthweights of 1.1 kg and 1 a09 kg. Twin one was in good condition and had an uneventful postnatal course. Twin two required minimal ventilatory support for 24 hours. Both 746 0 RCOG 1997 British Journal of Obstetrics and Gynaecology C A S E R E P O R T S 747infants were discharged home after 40 days and were well. The mother made an uneventful recovery with stabilisation of her blood ...

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Successful Pregnancy in a Churg-Strauss Syndrome Patient with a History of Intrauterine Fetal Death

Cited by 23 publications

References 1 publication

Successful treatment outcomes in pregnant patients with ANCA‐associated vasculitides: A systematic review of literature

Successful treatment outcomes in pregnant patients with ANCA‐associated vasculitides: A systematic review of literature

Old friends and friendly fire: Pregnancy, hookworm infection, and anemia among tropical horticulturalists

Churg‐Strauss disease: deterioration in a twin pregnancy. Successful outcome following treatment with corticosteroids and cyclophosphamide

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