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Management of preeclampsia with severe features in a patient with relapsing polychondritis affecting the
P Martín-Serrano1, E Sarrió-Badenes1, M Durá-Aranda1
1Department of Anaesthesiology and Resuscitation Complejo Hospitalario Universitario Insular Materno Infantil Las Palmas Spain.
Insights
Relapsing polychondritis (RP) in pregnancy is rare. This case highlights RP and severe preeclampsia, leading to acute respiratory failure after magnesium sulfate treatment.
Area of Science:
- Rheumatology
- Pulmonology
- Obstetrics
Background:
- Relapsing polychondritis (RP) is a rare multisystemic autoimmune disease characterized by progressive cartilage destruction.
- Respiratory involvement, including airway compromise, affects up to 50% of RP patients.
- Pregnancy can exacerbate RP symptoms, particularly laryngeal edema, and preeclampsia poses additional risks.
Observation:
- A pregnant patient with relapsing polychondritis presented with severe preeclampsia at 29 weeks and 6 days gestation.
- Following magnesium sulfate administration for preeclampsia, the patient developed acute respiratory failure.
- This presentation suggests a potential interaction between magnesium sulfate, preeclampsia, and RP-related airway compromise.
Findings:
- The combination of relapsing polychondritis and severe preeclampsia is exceptionally rare.
- Magnesium sulfate treatment may precipitate severe airway collapse in RP patients with preeclampsia.
- This case represents the first reported instance of this specific combination and complication.
Implications:
- Clinicians must be vigilant for respiratory compromise in pregnant patients with relapsing polychondritis, especially those with preeclampsia.
- Careful consideration of medication effects, such as magnesium sulfate, is crucial in managing these complex cases.
- This case underscores the need for multidisciplinary management involving rheumatologists, pulmonologists, and obstetricians to optimize maternal and fetal outcomes.
Abstract:
Relapsing polychondritis is a rare disease that affects cartilaginous structures throughout the body. Progressive destruction of the laryngeal structures and the tracheobronchial tree occurs in 50% of patients, potentially leading to loss of patency and collapse of the airway. Respiratory involvement in relapsing polychondritis includes airway stenosis, tracheomalacia and recurrent lung infections due to chronic inflammation caused by the destruction of upper and lower airway cartilage. Pregnancy and preeclampsia can worsen pharyngolaryngeal oedema, while treatment with magnesium sulphate can affect neuromuscular function, exacerbating the degree of airway collapse in the most serious cases of relapsing polychondritis, possibly altering obstetric outcomes. Here, we present the management of a pregnant woman with relapsing polychondritis who presented with features of severe preeclampsia at 29 weeks and 6 days gestation. We believe that this is the first published case of the combination of the two disorders, complicated by acute respiratory failure after treatment with magnesium sulphate.
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