Successful live birth following immunomodulatory therapy in a patient with multiple recurrent pregnancy loss and massive perivillous fibrinoid deposition.

Massive perivillous fibrinoid deposition (MPFD) is an extremely rare placental pathology associated with recurrent pregnancy loss and adverse perinatal outcomes. We present the case of a 41-year-old woman with systemic autoimmune disorders and a history of ten pregnancy losses, with histologically confirmed perivillous fibrinoid deposition in two available previous placental specimens and no evidence of chronic histiocytic intervillositis in the reviewed material. A personalized immunomodulatory protocol combining intravenous immunoglobulin (IVIg), corticosteroids, hydroxychloroquine, and antithrombotic therapy was associated with a successful full-term pregnancy, culminating in the live birth of a healthy infant by C-section. This case highlights the potential utility of tailored immunotherapy in complex recurrent pregnancy loss (RPL) cases associated with MPFD, although causal attribution to any single agent cannot be established given the single-case design, incomplete histological documentation of prior losses, and the simultaneous use of multiple interventions.