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A pregnant woman with severe dyspnoea

Mio Kanbe, Masakiyo Yatomi, Ikuo Wakamatsu, Shogo Uno, Chiharu Hanazato, Haruka Aoki-Saito, Tomomi Masuda, Koichi Yamaguchi, Norimitsu Kasahara, Yosuke Miura, Hiroaki Tsurumaki, Kenichiro Hara, Yasuhiko Koga, Noriaki Sunaga, Daisuke Higeta, Takashi Kameda, Takeshi Hisada, Toshitaka Maeno
Breathe 2022 18: 220012; DOI: 10.1183/20734735.0012-2022
Mio Kanbe
1Division of Allergy and Respiratory Medicine, Integrative Center of Internal Medicine, Gunma University Hospital, Maebashi, Japan
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Masakiyo Yatomi
1Division of Allergy and Respiratory Medicine, Integrative Center of Internal Medicine, Gunma University Hospital, Maebashi, Japan
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  • For correspondence: m09702007@gunma-u.ac.jp
Ikuo Wakamatsu
1Division of Allergy and Respiratory Medicine, Integrative Center of Internal Medicine, Gunma University Hospital, Maebashi, Japan
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Shogo Uno
1Division of Allergy and Respiratory Medicine, Integrative Center of Internal Medicine, Gunma University Hospital, Maebashi, Japan
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Chiharu Hanazato
1Division of Allergy and Respiratory Medicine, Integrative Center of Internal Medicine, Gunma University Hospital, Maebashi, Japan
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Haruka Aoki-Saito
1Division of Allergy and Respiratory Medicine, Integrative Center of Internal Medicine, Gunma University Hospital, Maebashi, Japan
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Tomomi Masuda
1Division of Allergy and Respiratory Medicine, Integrative Center of Internal Medicine, Gunma University Hospital, Maebashi, Japan
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Koichi Yamaguchi
1Division of Allergy and Respiratory Medicine, Integrative Center of Internal Medicine, Gunma University Hospital, Maebashi, Japan
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Norimitsu Kasahara
2Innovative Medical Research Center, Gunma University Hospital, Maebashi, Japan
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Yosuke Miura
1Division of Allergy and Respiratory Medicine, Integrative Center of Internal Medicine, Gunma University Hospital, Maebashi, Japan
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Hiroaki Tsurumaki
1Division of Allergy and Respiratory Medicine, Integrative Center of Internal Medicine, Gunma University Hospital, Maebashi, Japan
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Kenichiro Hara
1Division of Allergy and Respiratory Medicine, Integrative Center of Internal Medicine, Gunma University Hospital, Maebashi, Japan
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Yasuhiko Koga
1Division of Allergy and Respiratory Medicine, Integrative Center of Internal Medicine, Gunma University Hospital, Maebashi, Japan
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  • ORCID record for Yasuhiko Koga
Noriaki Sunaga
1Division of Allergy and Respiratory Medicine, Integrative Center of Internal Medicine, Gunma University Hospital, Maebashi, Japan
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Daisuke Higeta
3Dept of Obstetrics and Gynecology, Gunma University Hospital, Maebashi, Japan
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Takashi Kameda
3Dept of Obstetrics and Gynecology, Gunma University Hospital, Maebashi, Japan
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Takeshi Hisada
4Gunma University Graduate School of Health Sciences, Maebashi, Japan
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Toshitaka Maeno
1Division of Allergy and Respiratory Medicine, Integrative Center of Internal Medicine, Gunma University Hospital, Maebashi, Japan
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  • Article
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Figures

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  • FIGURE 1
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    FIGURE 1

    Pre-treatment a) chest radiograph, showing infiltration shadows in the upper right lobe and miliary shadows in both lungs; and b) CT scan, showing diffuse miliary shadows in both lungs.

  • FIGURE 2
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    FIGURE 2

    Clinical course of the mother in our hospital. Day 1 was the day of admission. The mother's general condition improved at discharge as a result of continued administration of anti-tuberculosis drugs and methylprednisolone. C-reactive protein (CRP) decreased and albumin recovered. Drug eruptions appeared twice, both of which were caused by antibiotics.

  • FIGURE 3
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    FIGURE 3

    Changes in chest radiographs. a) At the time of admission (on the first day, before delivery) the miliary shadow in both lungs and infiltration shadow in the right upper lobe are seen. b) On the third day after admission (following delivery), the infiltration shadow spread to both lungs, indicating ARDS. c) On the 15th day, at the time of withdrawal from the ventilator, the miliary and infiltration shadows in both lungs improved; and d) on the 21st day (discharge from our hospital), the infiltration shadow improved further, mainly in the left lung.

  • FIGURE 4
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    FIGURE 4

    a) Erythema on the upper right arm. b) Erythema expanding on the right arm, with no rash noted on other parts of the body.

  • FIGURE 5
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    FIGURE 5

    Changes in computed tomography findings. a) Miliary tuberculosis observed in both lungs at the time of admission. b) Persistence of infiltration shadow due to pneumonia developed during hospitalisation, noted before discharge from our hospital. c) Improved miliary and infiltration shadows compared to previous images.

Tables

  • Figures
  • TABLE 1

    Blood analyses

    ParameterValueNormal range
    Haematocrit, %32.235–45
    Haemoglobin, g·dL−110.111.8–15.1
    White blood cells, ×109 per L7.44.0–9.6
    Neutrophils, %91.842.2–73.2
    Eosinophils, %0.50.5–7.3
    Basophils, %0.10.0–1.8
    Monocytes, %2.22.2–8.4
    Lymphocytes, %5.420.1–47.3
    Platelets, ×109 per L275160–350
    Fibrinogen, mg·dL−1435150–330
    Prothrombin time/international normalised ratio0.970.85–1.23
    Fibrin/fibrinogen degradation products, µg·mL−119.40.0–4.0
    D-dimer, µg·mL−18.90.0–1.0
    Total protein, g·dL−14.76.3–7.9
    Serum albumin, g·dL−11.73.9–5.0
    Immunoglobulin G, mg·dL−1648870–1700
    Total bilirubin, mg·dL−10.60.3–1.2
    Alanine transaminase, U·L−1116–27
    Aspartate transaminase, U·L−12213–33
    Alkaline phosphatase, U·L−121338–113
    Lactate dehydrogenase, U·L−1325124–222
    Creatine kinase, U·L−13245–163
    Amylase, U·L−13437–125
    Serum sodium, mEq·L−1132136–147
    Serum potassium, mEq·L−13.63.6–5.0
    Serum chloride, mEq·L−110098–109
    Blood urea nitrogen, mg·dL−148–20
    Creatinine, mg·dL−10.450.46–0.79
    Brain natriuretic peptide, pg·mL−14.3≤18.4
    C-reactive protein, mg·dL−110.46≤0.14
    Sialylated carbohydrate antigen KL-6, U·mL−1838<500
    β-D-glucan, pg·dL−1<2.6≤20
    Aspergillus antigenNegativeNegative
    Mycoplasma pneumoniae antibody<40-fold<40-fold
    Cytomegalovirus antigenaemia testNegativeNegative
    Hepatitis B surface antibodyNegativeNegative
    Hepatitis C antibodyNegativeNegative
    HIV antibodyNegativeNegative
    COVID-19 antigen testNegativeNegative
    COVID-19 antibody testNegativeNegative
    T-SPOT.TB testPositiveNegative
    Arterial blood gas analysis#
     pH7.354
     PaO2, mmHg116
     PaCO2, mmHg39.8
     Base excess, mEq·L−1−3.0

    PaO2: arterial oxygen tension; PaCO2: arterial carbon dioxide tension. #: with oxygen 5 L·min−1 by face mask.

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    A pregnant woman with severe dyspnoea
    Mio Kanbe, Masakiyo Yatomi, Ikuo Wakamatsu, Shogo Uno, Chiharu Hanazato, Haruka Aoki-Saito, Tomomi Masuda, Koichi Yamaguchi, Norimitsu Kasahara, Yosuke Miura, Hiroaki Tsurumaki, Kenichiro Hara, Yasuhiko Koga, Noriaki Sunaga, Daisuke Higeta, Takashi Kameda, Takeshi Hisada, Toshitaka Maeno
    Breathe Jun 2022, 18 (2) 220012; DOI: 10.1183/20734735.0012-2022

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    A pregnant woman with severe dyspnoea
    Mio Kanbe, Masakiyo Yatomi, Ikuo Wakamatsu, Shogo Uno, Chiharu Hanazato, Haruka Aoki-Saito, Tomomi Masuda, Koichi Yamaguchi, Norimitsu Kasahara, Yosuke Miura, Hiroaki Tsurumaki, Kenichiro Hara, Yasuhiko Koga, Noriaki Sunaga, Daisuke Higeta, Takashi Kameda, Takeshi Hisada, Toshitaka Maeno
    Breathe Jun 2022, 18 (2) 220012; DOI: 10.1183/20734735.0012-2022
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    • An interesting case of pulmonary infiltrates with eosinophilia
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