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Lesson of the month: selective use of cyclophosphamide in pregnancy for severe autoimmune respiratory disease
  1. Catherine Nelson-Piercy1,
  2. Sangita Agarwal2,
  3. Boris Lams3
  1. 1Women's Health Academic Centre, Guy's & St Thomas' Foundation Trust (GSTFT), St Thomas' Hospital, London, UK
  2. 2Department of Rheumatology, GSTFT, London, UK
  3. 3Department of Respiratory medicine, GSTFT, London, UK
  1. Correspondence to Professor Catherine Nelson-Piercy, Women's Health Academic Centre, Guy's & St Thomas' Foundation Trust (GSTFT), 10th floor, North wing, St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK; Catherine.nelson-piercy{at}


We present the cases of two pregnant women who developed severe respiratory compromise in mid pregnancy, one due to rapidly progressive interstitial lung disease associated with mixed connective tissue disease and one secondary to diffuse alveolar haemorrhage due to antiglomerular basement membrane disease. Both were treated with high-dose steroids followed by pulsed intravenous cyclophosphamide. Both women went onto have live births although one baby was growth restricted and preterm. Neither baby had any evidence of congenital abnormalities.

  • Interstitial Fibrosis
  • Pulmonary vasculitis
  • Systemic disease and lungs

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