title: Lesson of the month: selective use of cyclophosphamide in pregnancy for severe autoimmune respiratory disease.
abstract: We present the cases of two pregnant women who developed severe respiratory compromise in mid pregnancy, one due to rapidly progressive interstitial lung disease associated with mixed connective tissue disease and one secondary to diffuse alveolar haemorrhage due to antiglomerular basement membrane disease. Both were treated with high-dose steroids followed by pulsed intravenous cyclophosphamide. Both women went onto have live births although one baby was growth restricted and preterm. Neither baby had any evidence of congenital abnormalities.
authors.affiliation: Women's Health Academic Centre, Guy's & St Thomas' Foundation Trust (GSTFT), St Thomas' Hospital, London, UK.
authors.forename: Catherine
authors.initials: C
authors.lastname: Nelson-Piercy
authors.affiliation: Department of Rheumatology, GSTFT, London, UK.
authors.forename: Sangita
authors.initials: S
authors.lastname: Agarwal
authors.affiliation: Department of Respiratory medicine, GSTFT, London, UK.
authors.forename: Boris
authors.initials: B
authors.lastname: Lams
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D019867:Anti-Glomerular Basement Membrane Disease / Q000188:drug therapy*; D001327:Autoimmune Diseases / Q000188:drug therapy*; D003520:Cyclophosphamide / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D017563:Lung Diseases, Interstitial / Q000188:drug therapy*; D008947:Mixed Connective Tissue Disease / Q000188:drug therapy*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy*; D011256:Pregnancy Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide
keywords: Interstitial Fibrosis; Pulmonary vasculitis; Systemic disease and lungs