Favorable course of pregnancy in a patient with rituximab-induced remission of granulomatosis with polyangiitis

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Granulomatosis with polyangiitis (GPA) is a rare autoimmune disease affecting small and medium-caliber arteries and mainly affecting the ENT organs, lungs and kidneys. Pregnancy in GPA patients is rare due to the development of the disease in most females over the age of 40–50 years. At the same time, when these conditions are combined, there is a high risk of exacerbation of GPA, which is life-threatening for the mother and requires the use of aggressive immunosuppression with potentially teratogenic drugs, which further increases the risk of complications for the fetus. Management of such a pregnancy requires careful monitoring and an interdisciplinary approach. Article contains a clinical observation of a young patient with severe lung damage associated with GPA, including the stages of diagnosis, selection of therapy, pregnancy and postpartum period. The aim of describing the presented clinical case is to illustrate the possibilities of a favorable pregnancy outcome for the mother and child when planning it during the period of GPA remission.

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作者简介

Maria Yupatova

V.I. Razumovsky Saratov State Medical University of the Ministry of Healthcare of Russia

编辑信件的主要联系方式.
Email: agent.smi@mail.ru
ORCID iD: 0000-0001-8120-4424
SPIN 代码: 4436-4561
Scopus 作者 ID: 59315471700

MD, assistant at the Department of hospital therapy of the Institute of clinical medicine

俄罗斯联邦, Saratov

Natalya Nikitina

V.I. Razumovsky Saratov State Medical University of the Ministry of Healthcare of Russia

Email: nikina02@yandex.ru
ORCID iD: 0000-0002-0313-1191
SPIN 代码: 6661-1830
Scopus 作者 ID: 24338688700

MD, Dr. Sci. (Medicine), head of the Department of hospital therapy of the Institute of clinical medicine

俄罗斯联邦, Saratov

Andrey Rebrov

V.I. Razumovsky Saratov State Medical University of the Ministry of Healthcare of Russia

Email: aprebrov@yandex.ru
ORCID iD: 0000-0002-3463-7734
SPIN 代码: 9574-2067
Scopus 作者 ID: 7005047527

MD, Dr. Sci. (Medicine), professor of the Department of hospital therapy of the Institute of clinical medicine, plenipotentiary representative of RSMSIM in the Volga Federal District

俄罗斯联邦, Saratov

参考

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  4. Partalidou S., Mamopoulos A., Dimopoulou D. et al. Pregnancy outcomes in ANCA-associated vasculitis patients: A systematic review and meta-analysis. Joint Bone Spine. 2023; 90(6): 105609. https://doi.org/10.1016/j.jbspin.2023.105609. PMID: 37419307.
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  7. Бекетова Т.В. Новые классификационные критерии АНЦА-ассоциированных системных васкулитов ACR/EULAR 2022. Научно-практическая ревматология. 2023; 61(5): 531–536. [Beketova T.V. New ACR/EULAR 2022 classification criteria for ANCA-associated vasculitis. Nauchcno-practicheskaya revmatologiya = Rheumatology Science and Practice. 2023; 61(5): 531–536 (In Russ.)]. https://doi.org/10.47360/1995-4484-2023-531-536. EDN: TBWODS.

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2. Fig. 1. Computed tomography of the chest organs of the patient observed on 06.08.2015: a rounded formation adjacent to the costal pleura, with air cavities in the structure (orange arrows)

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3. Fig. 2. Dynamics of computed tomography of the chest organs of the patient observed on 12/13/2017: reduction in the size of formations, disappearance of destruction cavities, formation of fibrosis in the surrounding tissues

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4. Fig. 3. Dynamics of computed tomography of the chest organs of the observed patient from 07/05/2018: newly formed cavities of destruction in the previously observed formation

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5. Fig. 4. Dynamics of computed tomography of the chest organs of the observed patient from 04/23/2019: pronounced fibrous changes in the lung tissues, deforming the costal pleura

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6. Fig. 5. Computed tomography of the chest organs of the observed patient from 03/11/2024: no formations in the lungs, single pleopulmonary adhesions (areas of fibrosis) at the site of the formations

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