Management of idiopathic pulmonary haemosiderosis in pregnancy: report of two cases.
Idiopathic pulmonary haemosiderosis (IPH) is a rare cause of alveolar haemorrhage. Its management in pregnancy is complicated and little clinical data exist on outcomes or treatment. Two patients with IPH, one with a known diagnosis prior to pregnancy (patient A) and one presenting de novo during pregnancy (patient B) are reported. Both subjects became maximally symptomatic in the third trimester and were treated with corticosteroids. Despite steroid treatment patient A had continued symptoms and was treated with azathioprine. Both patients delivered healthy female infants at 32 weeks and 38 weeks gestation, respectively. Patient B's course was complicated by the development of fatal invasive pulmonary aspergillosis 4 weeks postpartum. With improved care, more patients with IPH survive to childbearing age. Patients become most symptomatic late in pregnancy, underscoring the need for careful third trimester monitoring. These cases demonstrate that steroids are safe and that azathioprine can be used as additional therapy. When considering treatment options it is important to weigh the benefits of these medications against the potential for maternal and foetal harm.
Helman
Donald L
DL
Pulmonary and Critical Care Medicine Service, Department of Internal Medicine, Walter Reed Army Medical Center, Washington, DC, USA. doctornole@aol.com
Sullivan
Anthony
A
Kariya
Steven T
ST
Deering
Shad H
SH
Hueppchen
Nancy A
NA
Shorr
Andrew F
AF
D000328:Adult; D001228:Aspergillosis / Q000209:etiology; D001379:Azathioprine / Q000627:therapeutic use; D017809:Fatal Outcome; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006486:Hemosiderosis / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008171:Lung Diseases / Q000188:drug therapy*; D008172:Lung Diseases, Fungal / Q000209:etiology; D008775:Methylprednisolone / Q000627:therapeutic use; D011241:Prednisone / Q000627:therapeutic use; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy*; D011256:Pregnancy Outcome
D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D001379:Azathioprine; D011241:Prednisone; D008775:Methylprednisolone