Management of idiopathic pulmonary haemosiderosis in pregnancy: Report of two cases

:  Idiopathic pulmonary haemosiderosis (IPH) is a rare cause of alveolar haemorrhage. Its management in pregnancy is complicated and little clinical data exist on outcomes or treatment. Two patients with IPH, one with a known diagnosis prior to pregnancy (patient A) and one presenting de novo during...

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Published in:Respirology (Carlton, Vic.) Vic.), 2003-09, Vol.8 (3), p.398-400
Main Authors: HELMAN, Donald L., SULLIVAN, Anthony, KARIYA, Steven T., DEERING, Shad H., HUEPPCHEN, Nancy A., SHORR, Andrew F.
Format: Article
Language:English
Subjects:
Adult
alveolar haemorrhage
Aspergillosis - etiology
Azathioprine - therapeutic use
Fatal Outcome
Female
Glucocorticoids - therapeutic use
Hemosiderosis - complications
Hemosiderosis - drug therapy
Humans
idiopathic pulmonary haemosiderosis
Immunosuppressive Agents - therapeutic use
Lung Diseases - drug therapy
Lung Diseases, Fungal - etiology
Methylprednisolone - therapeutic use
Prednisone - therapeutic use
Pregnancy
Pregnancy Complications - drug therapy
Pregnancy Outcome
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Summary::  Idiopathic pulmonary haemosiderosis (IPH) is a rare cause of alveolar haemorrhage. Its management in pregnancy is complicated and little clinical data exist on outcomes or treatment. Two patients with IPH, one with a known diagnosis prior to pregnancy (patient A) and one presenting de novo during pregnancy (patient B) are reported. Both subjects became maximally symptomatic in the third trimester and were treated with corticosteroids. Despite steroid treatment patient A had continued symptoms and was treated with azathioprine. Both patients delivered healthy female infants at 32 weeks and 38 weeks gestation, respectively. Patient B's course was complicated by the development of fatal invasive pulmonary aspergillosis 4 weeks postpartum. With improved care, more patients with IPH survive to childbearing age. Patients become most symptomatic late in pregnancy, underscoring the need for careful third trimester monitoring. These cases demonstrate that steroids are safe and that azathioprine can be used as additional therapy. When considering treatment options it is important to weigh the benefits of these medications against the potential for maternal and foetal harm.
ISSN:1323-7799
1440-1843
DOI:10.1046/j.1440-1843.2003.00477.x