Successful pregnancy in patient with Wegener’s granulomatosis

Abstract

The prognosis of Wegener’s granulomatosis (WG), if untreated, is poor in most cases. Fatal outcome occurs due to pulmonary and heart failure, circulatory disorders, uremia and extreme exhaustion. The prognosis for such patients was significantly improved with the initiation of cyclophosphamide and glucocorticoid. Objective — clinical evaluation of Wegener's granulomatosis.Materials and methods. Clinical, laboratory, instrumental methods of research; analysis of available sources of literatureResults and discussion. As for treatment, the standard WG drug therapy is currently based on the oral administration of cyclophosphamide (2—3 mg/kg/day) in combination with glucocorticosteroids (GCS) in a dose equivalent to prednisone (1 mg/kg/day). GCS monotherapy somewhat improves the patient's state but has little effect on the prognosis. The effect of pregnancy on WG is unpredictable. The onset or exacerbation of the disease can occur at any time during pregnancy, but the trimester in which it occurs affects the treatment result and outcome. In this work, we present one of our own long-term follow-ups of a patient with WG who had two pregnancies and childbirth: the first in 2006 and the second in 2015 in the seventh year of the disease.Conclusions. Successful pregnancies and childbirth during the relapse of Wegener's granulomatosis are very rare, therefore young women should be strongly advised to plan a pregnancy during the remission period.The management of Wegener's granulomatosis during pregnancy should be strictly individual under the supervision of a multidisciplinary team of doctors. The choice of drugs, their doses and route of administration depend on the trimester of pregnancy and the severity of the disease.