Zayat Nawras, Arora Avish, O'Brien Joselle, Bal Japjot, Sugarman Rebekah, Rivera Leeshun, Shamshirsaz Amir, Vani Kavita, Mastrogiannis Dimitrios S
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York.
AJP Rep. 2024 May 24;14(2):e145-e155. doi: 10.1055/a-2318-0305. eCollection 2024 Apr.
This study aims to elucidate the clinical manifestations, diagnostic challenges, and management strategies of adult-onset Still's disease (AOSD) during pregnancy, leveraging a case series overview and a detailed case report from our center. A comprehensive review of 21 published case reports on AOSD diagnosed during pregnancy was conducted, alongside a detailed case report of a patient diagnosed and managed at our center. This study emphasizes the importance of recognizing AOSD in pregnant patients, outlines the therapeutic challenges encountered, and discusses the potential complications arising from the disease and its treatment. The onset of AOSD during pregnancy predominantly occurs in the first or second trimester, with a polycyclic disease course observed in most cases. Management primarily involves corticosteroids and immunosuppressive medications, balancing the disease control with potential pregnancy complications. The case report highlights the complex interplay between AOSD, hemophagocytic lymphohistiocytosis, and pregnancy, illustrating a multidisciplinary approach to management that ensured favorable maternal and fetal outcomes despite the significant challenges. AOSD presents unique diagnostic and therapeutic challenges during pregnancy, requiring careful consideration of maternal and fetal health. Early diagnosis, a multidisciplinary approach to care, and judicious use of immunosuppressive therapy are critical for managing AOSD flares and associated complications. Further research is necessary to optimize care for this rare condition in the context of pregnancy.
本研究旨在通过我们中心的病例系列概述和详细病例报告,阐明成人斯蒂尔病(AOSD)在妊娠期的临床表现、诊断挑战及管理策略。对21篇已发表的关于妊娠期诊断为AOSD的病例报告进行了全面综述,并结合我们中心诊断和管理的1例患者的详细病例报告。本研究强调了识别妊娠期AOSD患者的重要性,概述了遇到的治疗挑战,并讨论了该疾病及其治疗引起的潜在并发症。AOSD在妊娠期发病主要发生在孕早期或孕中期,大多数病例观察到多循环病程。管理主要涉及使用皮质类固醇和免疫抑制药物,在控制疾病的同时平衡潜在的妊娠并发症。该病例报告突出了AOSD、噬血细胞性淋巴组织细胞增生症和妊娠之间的复杂相互作用,说明了一种多学科管理方法,尽管面临重大挑战,但仍确保了良好的母婴结局。AOSD在妊娠期呈现独特的诊断和治疗挑战,需要仔细考虑母婴健康。早期诊断、多学科护理方法以及明智地使用免疫抑制治疗对于管理AOSD发作及相关并发症至关重要。有必要进行进一步研究,以优化对妊娠期这种罕见疾病的护理。