Use of High-Flow Nasal Cannula Oxygen Therapy in a Pregnant Woman with Dermatomyositis-Related Interstitial Pneumonia

Abstract

A 33-year-old pregnant woman was referred to our hospital with respiratory distress at 30 weeks of gestation. Chest computed tomography (CT) scans revealed pulmonary infiltrates along the bronchovascular bundles and ground-glass opacities in both lungs. Despite immediate treatment with steroid pulse therapy for suspected interstitial pneumonia, the patient's condition worsened. Respiratory distress was slightly alleviated after the initiation of high-flow nasal cannula (HFNC) oxygen therapy (40 L/min, FiO2 40%). We suspected clinically amyopathic dermatomyositis (CADM) complicating rapidly progressive refractory interstitial pneumonia. In order to save the life of the patient, the use of combination therapy with immunosuppressants was necessary. The patient underwent emergency cesarean section and was immediately treated with immunosuppressants while continuing HFNC oxygen therapy. The neonate was treated in the neonatal intensive care unit. The patient's condition improved after 7 days of hospitalization; by this time, she was positive for myositis-specific autoantibodies and was diagnosed with interstitial pneumonia preceding dermatomyositis. This condition can be potentially fatal within a few months of onset and therefore requires early combination immunosuppressive therapy. This case demonstrates the usefulness of HFNC oxygen therapy for respiratory management as it negates the need for intubation and allows for various treatments to be quickly performed.

Case Report: Rapidly Progressive Interstitial Lung Disease in A Pregnant Patient With Anti-Melanoma Differentiation-Associated Gene 5 Antibody-Positive Dermatomyositis

“…Examples of clinical case studies for treating pregnant patients with DM or PM, especially CADM, are relatively rare, and case studies of a similar nature that we were able to identify are shown in supplementary material (18,(26)(27)(28). Tomohiro et al (18). described the case of a 33-year-old pregnant woman who developed progressive interstitial pneumonia (IP) complicated by anti Jo-1 positive ASS at 28 weeks of gestation.…”

“…It has been suggested that immunosuppressants should be used early in patients with RP-ILD, since the damage caused to the pulmonary tissue may be irreversible once CADM is complicated by RP-ILD, which may result in the patient being irresponsive to combination immunosuppressive therapy, leading to death after only a few months (17). However, the use of immunosuppressants may not ensure rapid remission of the patient's condition (18). It was reported that combination immunosuppressive therapy consisting of high-dose corticosteroids, cyclosporine and intravenous immunoglobulin might be effective for CADM patients with RP-ILD (16).…”

Pregnancy in adult‐onset dermatomyositis/polymyositis: A systematic review

“…4 Only 2 of 68 pregnancies (2.94%) after DM/PM onset were complicated by hypertension 6 . The most frequently mentioned complication of DM/PM was interstitial lung disease 19–23 . The rate of cesarean delivery ranged from 23.3% 6 to 88.2% 5 (Supplementary Tables S1 and S2).…”

“…6 The most frequently mentioned complication of DM/PM was interstitial lung disease. [19][20][21][22][23] The rate of cesarean delivery ranged from 23.3% 6 to 88.2% 5 (Supplementary Tables S1 and S2).…”

Tweaking conventions: Use of high-flow nasal oxygen for intra-operative oxygenation in a parturient with severe COVID-19 acute respiratory distress syndrome

“…Also, haemodynamic perturbations frequently follow, which may affect the foetus. Though few reports of HFNO use during RA in severe ARDS exist,[ 5 ] it is infrequently used in the OR, although it may be a valuable alternative to intubation.…”