Obstetric Medicine > Volume 2, Number 2 > Pp. 77-80

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Case reports

Pregnancy complicating Wegener's granulomatosis

May Ching Soh MBChB FRACP   ^*, Hamish H Hart MBBCh FRACP    , Eileen Bass MBChB FRACP    and Lucille Wilkinson MBChB FRACP   

^* North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand; North Shore Hospital, North Shore City, Auckland, New Zealand; National Women's Health, Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand

Correspondence to: Hamish H Hart, Rheumatologist, North Shore Hospital, Private Bag 93 503, Takapuna, North Shore City, Auckland 0740, New Zealand Email: Hamish.Hart{at}waitematadhb.govt.nz

Pregnancy associated with Wegener's granulomatosis is rare. Therapeutic options are limited. There is a paucity of published literature to guide clinical decision-making in these complex patients. Two cases are presented. Firstly, a 33-year-old woman with generalized Wegener's in remission and off all medications presented with a flare in the third trimester with haemoptysis, raised C-reactive protein and c-anti-neutrophilic cytoplasmic antibody (c-ANCA) levels. Her care was complicated by florid steroid-induced psychosis. With deteriorating disease control, she was treated with pulsed-intravenous cyclophosphamide with a good response. She delivered a healthy baby at 38 weeks. She had a severe postpartum flare. Secondly, a 37-year-old woman with limited Wegener's in remission for the last two years and off all treatment became pregnant after pre-conception counselling. A normal baby was delivered at term. An exhaustive review of all published literature on Wegener's activity in pregnancy is presented along with therapeutic options and recommendations.

Key Words: Wegener's granulomatosis • pregnancy • haemoptysis • cyclophosphamide • steroid-induced psychosis

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