Pregnancy-Associated Onset of Adult-Onset Still's Disease

Nawras Zayat; Avish Arora; Joselle O'Brien; Japjot Bal; Rebekah Sugarman; Leeshun Rivera; Amir Shamshirsaz; Kavita Vani; Dimitrios S. Mastrogiannis

doi:10.1055/a-2318-0305

American Journal of Perinatology Reports, Table of Contents

CC BY-NC-ND 4.0 · AJP Rep 2024; 14(02): e145-e155
DOI: 10.1055/a-2318-0305

Review Article

Pregnancy-Associated Onset of Adult-Onset Still's Disease

Nawras Zayat

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York

,

Avish Arora

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York

,

Joselle O'Brien

³Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York

,

Japjot Bal

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York

,

Rebekah Sugarman

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York

,

Leeshun Rivera

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York

,

Amir Shamshirsaz

²Division of Maternal-Fetal Medicine and Surgical Critical Care, Baylor College of Medicine, Houston, Texas

,

Kavita Vani

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York

,

Dimitrios S. Mastrogiannis

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York

› Author Affiliations

Abstract

Objective 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.

Study Design 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.

Results 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.

Conclusion 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.

Keywords

adult-onset Still's disease - management of AOSD during pregnancy - rheumatology - disorders - Anakinra and pregnancy - hemophagocytic lymphohistiocytosis - pregnancy complications - macrophage activation syndrome

Full Text

References

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