Unrelieved exacerbation of familial Mediterranean fever during pregnancy


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Abstract

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. 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.

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About the authors

Tatyana V. Kirsanova

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: a_tatya@mail.ru
PhD, Senior Researcher of the Department of Transfusiology and Extracorporeal Hemocorrection Moscow, Russia

Varvara Yu. Yarotskaya

M.V. Lomonosov Moscow State University

Email: varvara.yarotskaya@gmail.com
Faculty of Fundamental Medicine Moscow, Russia

Natalia I. Klimenchenko

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia

Email: n_klimenchenko@oparina4.ru
Ph.D., Senior Researcher at the Department of Obstetric and Extragenital Pathology Moscow, Russia

Maria A. Vladykina

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Email: marvld792@gmail.com
Moscow, Russia

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