Successful pregnancy outcome in a multiparous lady with medical myriad-mixed connective tissue disorder, tuberculosis, chronic hypertension and recurrent pregnancy loss

Abstract

Autoimmune diseases/mixed connective tissue disorders are chronic and complex group of disorders with multi-systemic involvement. Untreated cases have significant morbidity and poor quality of life. There is a T helper cell paradigm from T helper1 to T helper 2 in pregnancy and autoimmune diseases may flare or improve in pregnancy depending on the type of autoimmune disease and pre-conception disease activity. There is enough evidence to support that individuals affected with autoimmune diseases are susceptible to tuberculosis (TB) infection and conversely auto-antibodies like antinuclear antibody, and rheumatoid factor are detected in sera of patients with active tuberculosis. If this association applies in pregnancy and if immunosuppressive state of pregnancy would further augment this association is not reported. We report a rare case of a 40 year old multigravida with mixed connective tissue disorder (MCTD) with features of systemic lupus erythematosus, deforming rheumatoid arthritis with gangrenous changes and auto-amputation of toes. She had reactivation of TB in the index pregnancy. She was also a chronic hypertensive, hypothyroid and had recurrent pregnancy losses. Index pregnancy was following invitro fertilisation (IVF) conception with donor oocyte and was managed by a multidisciplinary team in obstetric high dependency unit and delivered a healthy baby; both mother and baby were discharged in stable condition. We report this case as there are no reports of MCTD with active TB in pregnancy and to review if pregnancy affects the course of MCTD, TB or association between these two, and management options in such high risk cases.