Unrelieved exacerbation of familial Mediterranean fever during pregnancy
Background. Familial Mediterranean fever (FMF) is an inherited monogenic autosomal recessive systemic disease characterized by recurrent attacks of aseptic inflammation. During pregnancy, patients with FMF may both achieve sustained remission and preserve attacks. This paper describes a case of severe exacerbation of FMF in a pregnant patient who is in complete medicated remission.Kirsanova T.V., Yarotskaya V.Yu., Klimenchenko N.I., Vladykina M.A.
Case report. Patient Zh. was diagnosed with FMF in childhood. Colchicine therapy resulted in sustained remission. The first dichorionic diamniotic twin pregnancy occurred after IVF. Colchicine treatment was continued. The patient noted the renewal of severe pain syndrome, myalgia, and fever at 16 weeks’ gestation. At 24 weeks, she was admitted to the V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology. The therapy with higher colchicine doses showed no special effect; small positive changes were observed during pulse therapy with methylprednisolone. At 32–33 weeks’ gestation, the patient delivered preterm alive infants. After delivery, all FMF symptoms went away on their own; methylprednisolone was discontinued gradually; the dose of colchicine was reduced.
Conclusion. The described case emphasizes the importance of an individual approach to achieving a favorable outcome. FMF cannot be an obstacle and a contraindication for pregnancy planning in reproductive-aged women, provided that each case is managed in a personalized manner.
Keywords
familial Mediterranean fever
pregnancy
in vitro fertilization
colchicine
case report
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Received 10.02.2021
Accepted 16.06.2021
About the Authors
Tatyana V. Kirsanova (Corresponding author), PhD, Senior Researcher of the Department of Transfusiology and Extracorporeal Hemocorrection, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia. Tel.: +7(926)248-45-60. E-mail: a_tatya@mail.ru.ORCID: 0000-0002-6125-590X. 117997, Russia, Moscow, Academician Oparin str., 4.
Varvara Yu. Yarotskaya, Lomonosov Moscow State University, Faculty of Fundamental Medicine. Tel.: +7(985)842-59-02. E-mail: varvara.yarotskaya@gmail.com. ORCHID: 0000-0002-9524-0757. 119991, Russia, Moscow, Lomonosovsky Prospekt, 27-1.
Natalia I. Klimenchenko, Ph.D., Senior Researcher at the Department of Obstetric and Extragenital Pathology, Academician V.I. Kulakov National Medical Research Center
for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia. Tel.: +7(903)756-45-72. E-mail: n_klimenchenko@oparina4.ru. ORCID: 0000-0002-9901-225X.
117997, Russia, Moscow, Academician Oparin str., 4.
Maria A. Vladykina, I.M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, Institute of Clinical Medicine.
Tel.: +7(977)545-61-49. E-mail: marvld792@gmail.com. ORCHID: 0000-0003-4239-8769. 119991, Russia, Moscow, Trubetskaya str., 8-2.
For citation: Kirsanova T.V., Yarotskaya V.Yu., Klimenchenko N.I., Vladykina M.A. Unrelieved exacerbation of familial Mediterranean fever during pregnancy.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2021; 8: 230-234 (in Russian).
https://dx.doi.org/10.18565/aig.2021.8.230-234
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