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- W2894080940 abstract "Introduction Inflammatory myositis’ (IM) encompasses multi-systemic autoimmune conditions including dermatomyositis (DM), polymyositis (PM) and myositis-overlaps. Diagnostic delays reflect the rarity of IM (1–6 per 1,000,000), the varying presentations associated and a dismissal of symptoms as ‘normal for pregnancy’. Immunosuppression is often withheld unduly. Objectives We aim to increase the awareness of this aggressive yet treatable condition. Methods We describe 4 cases of IM treated in pregnancy. 31 yr multigravida: Known autoimmune disease (hypothyroidism and type-1-diabetes) presents with varying symptoms throughout pregnancy: fatigue and proximal myopathy (12/40), shawl rash (22/40), pneumonia requiring intubation (25/40) and pre-eclampsia (PET) necessitating caesarean section (CS) (26/40). Post-partum, ECMO was required for a progressive organising pneumonia. The unifying diagnosis was DM, treated with IV methylprednisolone (IVMP), rituximab and cyclosporine. 35 yr multigravida: Complicated by gestational diabetes, unexplained transaminitis and proteinuria presented 38/40 with an intrauterine death. Post-partum a photosensitive rash (2/52), inflammatory arthritis (4/52) and organising pneumonia (11/52) developed. CK was normal. MDA-5 (amyopathic) DM was diagnosed and treated with IVMP, cyclophosphamide and methotrexate. 39 yr primip: Known RNA-polymerase diffuse systemic sclerosis (SSc) presented with dyspnoea and orthopnoea, requiring intubation (7/40). CK, troponin and BNP were elevated and myositis-overlap SSc with cardiac, proximal muscle and gastrointestinal involvement diagnosed. Treatment included IVMP and intravenous immunoglobulin. Steroid-sparing agents (azathioprine and rituximab) were instituted to avoid a renal-crisis. She remains pregnant. 30 yr primip: Known anti-SRP (necrotising) myositis, presented with proximal myopathy, respiratory muscle weakness and CK rise (12/40) following discontinuation of maintenance therapy. Re-treated with IVMP and rituximab at 16/40. Emergency CS (32 + 4/40) was performed for placenta praevia. Results Despite extreme presentations of IM peri-partum, all 4 patients were treated aggressively with complete resolution of symptoms. Obstetric outcomes were less favourable. Discussion Rituximab is effective and safe in early pregnancy. Pregnancy should not be a barrier to early diagnosis or treatment." @default.
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- W2894080940 date "2018-10-01" @default.
- W2894080940 modified "2023-09-24" @default.
- W2894080940 title "408. Inflammatory myositis in pregnancy. The value of early diagnosis and aggressive treatment: A case series" @default.
- W2894080940 doi "https://doi.org/10.1016/j.preghy.2018.08.435" @default.
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