TY - JOUR
T1 - Successful Pregnancy and Delivery of a Healthy Newborn Despite Transplacental Transfer of Antimyeloperoxidase Antibodies From a Mother With Microscopic Polyangiitis
AU - Silva, Francisco
AU - Specks, Ulrich
AU - Sethi, Sanjeev
AU - Irazabal, Maria Valentina
AU - Fervenza, Fernando C.
N1 - Funding Information:
Support: Dr Silva receives funds from the Mayo Foundation and has received a Fellowship Award from the Vasculitis Clinical Research Consortium (U54-RR-019497).
PY - 2009/9
Y1 - 2009/9
N2 - Myeloperoxidase (MPO)-specific antineutrophil cytoplasmic antibodies have been proposed as pathogenic for microscopic polyangiitis. Supporting this hypothesis, a case report of transplacental anti-MPO antibody transfer presumably causing a vasculitis-like syndrome in the newborn is cited frequently. Here, we report a case of transplacental transfer of high levels of anti-MPO antibodies not resulting in clinical compromise in the newborn. The mother developed microscopic polyangiitis 5 years before the pregnancy. After induction therapy, remission was maintained with low-dose prednisone and azathioprine for 4.5 years despite high levels of anti-MPO antibodies (>100 U/mL). The patient elected to become pregnant, immunosuppression was maintained during pregnancy, and a normal-term neonate was delivered. The newborn's venous blood anti-MPO antibody levels decreased gradually from greater than 100 U/mL at birth to undetectable by day 120. No clinical manifestation of vasculitis developed in the newborn. This case supports that anti-MPO antibodies alone are not pathogenic without additional cofactors.
AB - Myeloperoxidase (MPO)-specific antineutrophil cytoplasmic antibodies have been proposed as pathogenic for microscopic polyangiitis. Supporting this hypothesis, a case report of transplacental anti-MPO antibody transfer presumably causing a vasculitis-like syndrome in the newborn is cited frequently. Here, we report a case of transplacental transfer of high levels of anti-MPO antibodies not resulting in clinical compromise in the newborn. The mother developed microscopic polyangiitis 5 years before the pregnancy. After induction therapy, remission was maintained with low-dose prednisone and azathioprine for 4.5 years despite high levels of anti-MPO antibodies (>100 U/mL). The patient elected to become pregnant, immunosuppression was maintained during pregnancy, and a normal-term neonate was delivered. The newborn's venous blood anti-MPO antibody levels decreased gradually from greater than 100 U/mL at birth to undetectable by day 120. No clinical manifestation of vasculitis developed in the newborn. This case supports that anti-MPO antibodies alone are not pathogenic without additional cofactors.
KW - Vasculitis
KW - antineutrophil cytoplasmic antibodies (ANCAs)
KW - microscopic polyangiitis (MPA)
KW - myeloperoxidase (MPO)
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U2 - 10.1053/j.ajkd.2009.02.016
DO - 10.1053/j.ajkd.2009.02.016
M3 - Article
C2 - 19395136
AN - SCOPUS:68849126289
SN - 0272-6386
VL - 54
SP - 542
EP - 545
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 3
ER -