Outcome of Pregnancy in a Patient with Relapsing Polychondritis and Pyoderma Gangrenosum

We report a patient with relapsing polychondritis (RP) who developed pyoderma gangrenosum (PG) during pregnancy and gave birth to a healthy female infant. A 30-year-old woman, para 1, presented to our antenatal clinic at 6 weeks of gestation. She had been treated with corticosteroids for RP since she was 11 years old [1]. She had conceived spontaneously and until the 6th week of gestation she was receiving methylprednisolone 32 mg every other day. At the 8th week of gestation she presented a large painful skin ulcer involving the extensor surface of the right leg. Histological examination showed a necrotic ulcer (Fig. 1). The diagnosis of PG was made [2]. Oral azathioprine (AZA) 150 mg/ day was added after the 12th week and the PG showed a good response. After the 28th week, fetal growth and condition, assessed by ultrasound and Doppler velocimetry of the umbilical artery, were found to be accurate for gestation. At 37 weeks and 3 days she gave birth to a healthy 3080 g female infant by Caesarian section, because of failure of the trial of labour. RP and PG are considered to have an autoimmune basis [1,2]; both conditions were well controlled by immunosuppressive drugs such as corticosteroids and AZA [3]. These drugs are considered to be safe in pregnant women [3,4]. In order to achieve a better outcome of pregnancy in RP and PG patients, it is essential to control disease activity. Close follow-up, monitoring and ultrasound studies will improve fetal survival and reduce disease flare rates in these patients.