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Adult-Onset Still’s Disease in Pregnancy: Lessons Learned and an Approach to Subsequent Pregnancies

  • Maternal Fetal Medicine/Biology: Case Study
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Abstract

Adult-onset Still’s disease (AOSD) is a rare autoinflammatory disorder with potential for life-threatening complications in pregnancy. Recently, biologic therapeutics have been increasingly used for treatment of AOSD, but there is little available data on the treatment of AOSD in pregnancy. Here we report a 23-year-old primigravid patient with a history of AOSD who presented at 20 weeks of gestation with fever, arthralgias, rash, fatigue, and highly elevated ferritin, concerning for AOSD flare. She was treated with tocilizumab, an interleukin-6 receptor antagonist, with rapid clinical and laboratory improvement; however, she underwent iatrogenic preterm delivery at 34 weeks of gestation for fetal distress, which was attributed to placental injury. In a subsequent pregnancy, she was treated with tocilizumab throughout and had an uncomplicated term delivery with normal labs and no AOSD flare. This case highlights that the use of tocilizumab may be effective to reduce the risk of AOSD flare during pregnancy.

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De-identified data is available upon request to corresponding author.

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Acknowledgements

The authors thank the Obstetrics and Rheumatology staff for assistance in clinical care. SM is supported by the Reproductive Scientist Development Program K12HD000849 from the Eunice Kennedy Shriver National Institute of Child Health & Human Development and the Burroughs Wellcome Fund.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Washington, 1959 NE Pacific St, Box 356460, Seattle, WA, 98195, USA

    Carolina Martinez-King & Stephen A. McCartney

  2. Department of Medicine, Division of Rheumatology, University of Washington, Seattle, WA, USA

    Sarah H. Chung

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  1. Carolina Martinez-King
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  2. Sarah H. Chung
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  3. Stephen A. McCartney
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Correspondence to Stephen A. McCartney.

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Approval for this study was obtained from the University of Washington IRB (STUDY00017377).

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The authors declare no competing interests.

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Martinez-King, C., Chung, S.H. & McCartney, S.A. Adult-Onset Still’s Disease in Pregnancy: Lessons Learned and an Approach to Subsequent Pregnancies. Reprod. Sci. 30, 3515–3519 (2023). https://doi.org/10.1007/s43032-023-01296-8

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  • DOI: https://doi.org/10.1007/s43032-023-01296-8

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