Granulomatosis with polyangiitis and pregnancy: Anti‐neutrophil cytoplasmic antibody, placental inflammation, chorangiosis and pre‐eclampsia

Abstract

Granulomatosis with polyangiitis (GPA) is a rare necrotizing autoimmune disease involving small vessel vasculitis. Pregnancies with GPA have increased rates of obstetric complications including pre‐eclampsia. Differential diagnosis of GPA flares up and pre‐eclampsia may be difficult and necessitates careful clinical practice. A 26‐year‐old pregnant woman with GPA was referred for hypertension. The absence of GPA signs and symptoms, negative anti‐neutrophil cytoplasmic antibody titer and the presence of clinical and laboratory findings supported the diagnosis of pre‐eclampsia rather than a GPA flare‐up. The newborn was delivered via cesarean section at the 30th gestational week due to severe superimposed pre‐eclampsia. Pathological examination of the placenta demonstrated the presence of chorangiosis and focal placental infarcts. GPA should be considered as a risk factor in pregnancy and requires careful clinical management to have good gestational outcome. Physicians should be vigilant regarding gestational diabetes and pre‐eclampsia as well as GPA flare‐up.