Pregnancy in women diagnosed with antineutrophil cytoplasmic antibody-associated vasculitis: outcome for the mother and the child.

OBJECTIVE: Antineutrophil cytoplasmic antibody-associated vasculitis (AAV) is infrequently seen in women of childbearing age. Only a limited number of pregnancies in women with AAV have been reported, and often they were associated with complications. METHODS: This was a single-center retrospective observational study. All pregnancies in women with granulomatosis with polyangiitis (Wegener's) (n = 13) and microscopic polyangiitis (n = 1) were included. Women of childbearing age were counseled to abstain from pregnancy during or shortly after disease activity or <1 year after cyclophosphamide treatment. RESULTS: We described 22 pregnancies in 14 women with AAV (median age at diagnosis was 25 years [range 19-36 years]) diagnosed between 1982-2008. The ear, nose, and throat region (71%) and kidneys (50%) were predominantly involved. All women were in remission at conception and cyclophosphamide had been administered to 9 women (15 pregnancies). The median gestational age was 39+4 weeks, including 2 preterm deliveries. The median birth weight was 3,400 gm (1,860-3,890 gm). Hypothyroidism occurred in 1 newborn and a cleft palate in 1 newborn of a twin pregnancy. Otherwise, the fetal outcome was excellent. Preeclampsia was diagnosed in 2 pregnancies. A caesarean section was performed in 2 patients. The median followup after the last conception was 98 months (range 11-307 months). Eight women experienced a relapse 21 months (range 7-62 months) after conception, 1 during pregnancy, and 7 after delivery. CONCLUSION: In this study, the pregnancy outcome in patients with AAV in remission was excellent. Pregnancy in women with AAV in remission does not seem to be associated with increased risk of relapse. Counseling, careful management, and close followup are essential in pregnant women with AAV.

Orthostatic proteinuria: a harmless variant of protein loss?

A 28-year-old young woman was referred to our department of Internal Medicine for analysis of unintentional weight loss. At initial analysis, a persistent proteinuria was found with no evident relation to her weight loss. Anamnestic as well as additional studies showed no evidence of a primary kidney disease. After this exclusion, orthostatic proteinuria was confirmed by simple urine analysis. Since the weight loss had not yet been explained, an analysis followed at the Department of Gastointestinal and Liver Diseases where inflammatory bowel disease (IBD) was found. Literature study shows that proteinuria may be associated with IBD. This concerns mainly selective tubular protein loss, without a distinctive change in protein loss with a change in position. Orthostatic proteinuria, therefore, remained the most likely diagnosis. In this case, the patient was advised to check both urine and kidney function annually.

[Bacterial meningitis following spinal anaesthesia]. / Bacteriële meningitis na spinale anesthesie.

A 37-year-old man in a status epilepticus due to meningitis was admitted to Intensive Care because of respiratory insufficiency. Spinal fluid culture yielded Streptococcus salivarius. Despite extensive diagnostics, the source of this bacterium could not be found. However, the patient had recently undergone spinal anaesthesia for surgery on a toe ulcer, from which other bacteria were cultured. The patient died 2 weeks after admission with a picture of multiple organ failure. Bacterial meningitis following spinal anaesthesia may be the result of impairment of the blood-brain barrier due to a sudden drop of spinal fluid pressure during the puncture, or of the introduction of bacteria from the hair follicles or from a haematoma caused by the needle or the introducer. Hygienic measures and a proper technique when performing regional anaesthesia are important in preventing the dissemination of bacteria.