High-risk twin pregnancy : case report of an adolescent patient with cystic fbrosis and systemic lupus erythematosus

Abstract

Background: We present the frst case to our knowledge of a spontaneous twin pregnancy in a 16-year-old Caucasian patient with cystic fbrosis and systemic lupus erythematosus. Cystic fbrosis is one of the most common autosomal recessive genetic disorders and primarily afects the respiratory and digestive systems. Systemic lupus erythematosus is a chronic infammatory disease of unknown cause that afects nearly every organ. Patients with cystic fbrosis or systemic lupus erythematosus are progressively having longer life expectancy and better quality of life, which has led a greater number of female patients reporting the desire to become mothers. Case presentation: We present a case of a Caucasian 16-year-old pregnant with twins being treated for both cystic fbrosis and systemic lupus erythematosus. She has two CFTR mutations: p.F508del and 1812_1G>A. In the second trimester, she was admitted for possible preterm labor, which was successfully stopped. The patient’s nutritional status worsened, and she had a pulmonary exacerbation as well as a fare of systemic lupus erythematosus. At the 28th gestational week, she presented with a massive hemoptysis episode. The cesarean delivery had no complications, and there were no serious immediate postpartum complications. Discussion and conclusions: While adolescent pregnancies in and of themselves are considered high risk for both the young mothers and their children, they are further complicated when the mother has two chronic diseases and a twin pregnancy. We achieved positive results using a multidisciplinary approach; however, the risks involved were so high that major eforts are to be taken by our medical community to prevent unplanned pregnancies in all patients with cystic fbrosis, especially when a serious comorbidity like the one in this case is present.