Dr Nayomi Perera1, Dr John Zhu2, Dr Freya Berenyi2, Dr Sarah Price1, Dr Jyotika Prasad2,3
1Department of Obstetric Medicine, Royal Women's Hospital, Parkville, Australia, 2Department of Respiratory, Royal Melbourne Hospital, Parkville, Australia, 3Department of Respiratory, Alfred Hospital, Melbourne, Australia
Biography:
Nayomi is a current obstetric medicine fellow at the Royal Women's hospital. She has completed her training in Endocrinology and General medicine.
Abstract:
A 33-year-old primigravida, recently migrated from India, was referred at 9 weeks gestation with a wanted, planned pregnancy, in the context of moderate-severe connective tissue disease interstitial lung disease (CTD-ILD). Her medical history is significant for previously treated latent tuberculosis, with a stable right upper lobe calcified lesion. A high-resolution computer tomography (CT) scan performed upon migration one year earlier confirmed a stable lesion. However this scan incidentally diagnosed ILD and she was subsequently confirmed to have scl-70 positive scleroderma. Respiratory function tests revealed a severe restrictive deficit and severely reduced DLCO. Bronchoscopy was negative for tuberculosis and she had been managed with two cycles of Rituximab 3 months prior to pregnancy.
She is a non-smoker, works as a personal care assistant in aged care, and experiences dyspnea with moderate exercise and is limited to a single flight of stairs. The patient expressed a strong desire to continue the pregnancy despite recommendations for termination to preserve maternal health and prevent further respiratory deterioration, which could potentially necessitate a lung transplant. At 14 weeks gestation, multidisciplinary team initiated further immunosuppression with prednisolone, plan for azathioprine in hopes to delay ILD progression. Repeat CT imaging noted new cavitation of the upper lobe lesion. A repeat bronchoscopy confirmed active cavitary pulmonary tuberculosis, likely reactivation secondary to recent rituximab treatment. Azathioprine commencement was postponed, and first-line tuberculosis treatment was commenced. Active tuberculosis precludes the possibility of lung transplantation until adequately treated. This case report will follow the respiratory, maternal, and fetal outcomes of this complex case.
Compromised respiratory function poses significant challenges during pregnancy, ILD is rarely seen in pregnant women. Both ILD and tuberculosis can have adverse maternal and fetal consequences in pregnancy. This case report presents the first documented instance of ILD concurrent with active tuberculosis in a pregnant patient.
Keywords
Interstitial lung disease, Tuberculosis