Mrs. G.S. had recurrent skin infections and abscesses on her breast, left and right arm, requiring about 30 drainage operations leaving multiple scars on the skin of upper limbs(Fig. 1) , lower limbs(Fig. 2) , and breasts(Fig. 3) . She was diagnosed with CGD in 2003 at age 17 using the nitroblue tetrazolium dye reduction test. She also experienced recurrent vaginal infections and pelvic inflammatory disease post-marriage.

Her mother died of breast cancer five years after giving birth to her. She was undergoing chemotherapy when she discovered her pregnancy, and her father succumbed to liver cancer. There was no consanguinity between her parents. She is the youngest of four siblings, and none of them have CGD.

Drug history: She is allergic to ampicillin and cephalosporin, and she has become allergic to almost all injectable antibiotics, including meropenem.

Pregnancy poses a particular challenge for patients with CGD due to the immunological changes that occur during this period. The immune system undergoes modulation during pregnancy to prevent fetal rejection, which can affect the progression of autoimmune and infectious diseases.^[14,15] This patient experienced significant worsening of CGD symptoms during pregnancy, including panophthalmitis and recurrent abscess drainage. These complications required intensified medical intervention and highlighted the increased susceptibility to severe infections during pregnancy in CGD patients. Postpartum, the patient’s symptoms resumed their previous pattern, indicating the temporary exacerbation during pregnancy. This observation aligns with limited existing literature suggesting that the immunomodulatory state of pregnancy can temporarily alter the clinical course of CGD.^[16–18]

The patient delivered a healthy baby girl, who began manifesting symptoms of CGD at two months old. The typical age of onset for CGD symptoms varies, but early infancy is common, as seen in this case.^[19,20] The detailed documentation of the clinical management and outcomes provides valuable insights into the complexities of managing CGD during pregnancy and the importance of a multidisciplinary approach.^[21–23]

The management of infections in CGD relies heavily on the use of prophylactic and therapeutic antibiotics. During pregnancy, the patient was treated with meropenem, metronidazole, and erythromycin, all of which have been used to manage severe infections in CGD patients.^[24]

The manuscript includes detailed information on the antibiotics used, including dosages and durations of treatment. The patient was treated with a combination of meropenem, metronidazole, and erythromycin tailored to her specific infections, with close monitoring to prevent adverse effects. This case underscores the importance of individualized treatment plans in CGD patients, particularly during pregnancy.^[28]

One intriguing aspect of this case is the patient’s development of myasthenia gravis and subsequent Cushing syndrome. While the coexistence of autoimmune disorders in CGD patients is documented, the precise mechanisms remain unclear. The potential impact of immunosuppressive therapies and the interplay between genetic and environmental factors warrant further investigation.^[29]

The role of maternal chemotherapy in the pathogenesis of CGD in offspring also presents an area for future research. Although there is no direct evidence linking maternal chemotherapy to CGD, the potential for genetic and epigenetic modifications cannot be dismissed.^[30–32] This case underscores the importance of genetic counseling and the need for comprehensive prenatal care in managing pregnancies complicated by CGD.^[33]

Furthermore, the absence of advanced genetic diagnostic tools in our region poses significant challenges in the management of CGD. The reliance on clinical presentation and basic diagnostic tests limits the ability to provide precise and early diagnosis, which is crucial for optimal management and genetic counseling. Genetic testing is crucial in the diagnosis and management of CGD. Despite regional limitations, the potential benefits of genetic testing have been discussed in the manuscript, emphasizing the importance of genetic counseling for family planning and early diagnosis. Future steps include pursuing genetic investigations to better understand the hereditary patterns and to provide targeted care for affected individuals.^[33]

CGD should be considered in patients presenting with aggressive and recurrent infections. Early diagnosis and prompt management are crucial to improving outcomes.

Despite the lack of consanguinity, CGD can still be inherited. Genetic counseling should be offered to families with a history of CGD to inform them about the risks and implications for offspring.

Further studies are needed to explore the potential causative role of maternal chemotherapy in the development of CGD in offspring. This could provide insights into preventive strategies and better prenatal management.

This case highlights the complexities of managing CGD during pregnancy, emphasizing the need for a multidisciplinary approach and individualized treatment plans. The temporary exacerbation of CGD symptoms during pregnancy, the successful management of severe infections with antibiotics, and the documentation of autoimmune complications provide valuable insights into the interplay between pregnancy and CGD. Pregnant women with CGD require comprehensive prenatal care, including close monitoring for infections and appropriate antibiotic therapy to ensure maternal and fetal well-being.

There is a critical need for the development and implementation of advanced genetic diagnostic tools in regions lacking such facilities. This would enable early detection, appropriate management, and better genetic counseling for CGD patients and their families.

The co-occurrence of autoimmune disorders such as myasthenia gravis in CGD patients necessitates a multidisciplinary approach to manage these complex cases effectively.