title: Postpartum onset and subsequent relapse of eosinophilic granulomatosis with polyangiitis.
abstract: Eosinophilic granulomatosis with polyangiitis (EGPA) can affect women of childbearing age. However, reports of the disease in the postpartum period are limited. We present a case of postpartum-onset EGPA that went into clinical remission before relapsing in the subsequent postpartum period. Our patient presented with dyspnoea, arthralgia and rash, shown to be eosinophilic vasculitis, 3 days following the birth of her second child. CT of the thorax showed alveolar shadowing and mediastinal lymphadenopathy. She was treated successfully for EGPA with glucocorticoid therapy. She declined maintenance treatment during remission. Off treatment, she remained disease free throughout her next pregnancy. In the postpartum period she relapsed in an almost identical manner, requiring prolonged glucocorticoid therapy, cyclophosphamide and rituximab. This case highlights the importance of maintenance therapy around pregnancy in individuals with EGPA, and the need for careful monitoring of women with a history of EGPA in the postpartum period.
authors.affiliation: MRC Lifecourse Epidemiology Unit, Southampton General Hospital, Southampton, UK.
authors.forename: Mark Hiley
authors.initials: MH
authors.lastname: Edwards
authors.affiliation: MRC Lifecourse Epidemiology Unit, Southampton General Hospital, Southampton, UK.
authors.forename: Elizabeth Mary
authors.initials: EM
authors.lastname: Curtis
authors.affiliation: Rheumatology Department, Queen Alexandra Hospital, Portsmouth, UK.
authors.forename: Joanna Mary
authors.initials: JM
authors.lastname: Ledingham
mesh_terms: D000328:Adult; D001249:Asthma / Q000150:complications; D003520:Cyclophosphamide / Q000627:therapeutic use; D003937:Diagnosis, Differential; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D014890:Granulomatosis with Polyangiitis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D049590:Postpartum Period; D011239:Prednisolone / Q000627:therapeutic use; D012008:Recurrence
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D011239:Prednisolone