Cicek Demet, Kandi Basak, Demir Betul, Turgut Dilara
Department of Dermatology, Firat University Faculty of Medicine, Elazig, Turkey.
Skinmed. 2007 Nov-Dec;6(6):298-301. doi: 10.1111/j.1540-9740.2007.06387.x.
A 23-year-old woman presented to our polyclinic complaining of itching, generalized dermatitis, and jaundice. She was in her 31st gestational week and had developed pruritus and the dermatitis since the first month of pregnancy; her jaundice started about a month before presentation. Her history included similar complaints in a previous pregnancy, which resulted in premature birth of a baby with a permanent brain defect. One of her sisters had had jaundice and itching in her 27th gestational week and delivered a healthy baby; a second sister had experienced itching and dermatitis in her second trimester and delivered a healthy baby. Physical examination of the patient showed that her eyes were jaundiced (Figure 1); skin examination revealed generalized erythematous excoriated papules, symmetrically distributed all over her body (Figure 2 Figure 3). Laboratory analyses revealed the following results: leukocyte count, 14.30/mm(3) (3.8-10.3/mm(3)); erythrocyte sedimentation rate, 25 mm/h (<20 mm/h); aspartate aminotransferase, 44 U/L (5-40 U/L); alanine aminotransferase, 63 U/L (5-40 U/L); lactate dehydrogenase, 1158 U/L (220-450 U/L); total bilirubin, 6.88 mg/dL (<1.10 mg/dL); and direct bilirubin, 3.27 mg/dL (<0.35 mg/dL). Urinalysis results were positive for bilirubin and urobilinogen. Positive serologic findings included rubella immunoglobulin G, 93 AU/mL (<15) and cytomegalovirus, 188 AU/mL (<10); negative findings included herpes simplex virus type 2 and hepatitis. Histopathologic examination of material collected from the left breast via punch biopsy showed parakeratosis, acanthosis, and perivascular lymphocyte infiltration in dermal vessels. Treatment with 2 g/d cholestyramine and a topical corticosteroid was effective in the patient, who was diagnosed with intrahepatic cholestasis of pregnancy and prurigo of pregnancy based on the clinical, histopathologic, and laboratory findings. To the authors' knowledge, this is the first such reported case in the literature.
一名23岁女性到我们的综合诊所就诊，主诉瘙痒、全身性皮疹和黄疸。她处于妊娠第31周，自妊娠第一个月起就出现了瘙痒和皮疹；黄疸在就诊前约一个月开始出现。她的病史包括前次妊娠时有类似症状，那次妊娠导致一名患有永久性脑缺陷的婴儿早产。她的一个姐妹在妊娠第27周时出现黄疸和瘙痒，并生下一个健康的婴儿；另一个姐妹在妊娠中期出现瘙痒和皮疹，并生下一个健康的婴儿。对该患者的体格检查显示其眼睛黄疸（图1）；皮肤检查发现全身性红斑性抓破丘疹，对称分布于全身（图2、图3）。实验室分析结果如下：白细胞计数14.30/mm³（3.8 - 10.3/mm³）；红细胞沉降率25mm/h（<20mm/h）；天冬氨酸转氨酶44U/L（5 - 40U/L）；丙氨酸转氨酶63U/L（5 - 40U/L）；乳酸脱氢酶1158U/L（220 - 450U/L）；总胆红素6.88mg/dL（<1.10mg/dL）；直接胆红素3.27mg/dL（<0.35mg/dL）。尿液分析结果显示胆红素和尿胆原呈阳性。血清学检查阳性结果包括风疹免疫球蛋白G 93AU/mL（<15）和巨细胞病毒188AU/mL（<10）；阴性结果包括2型单纯疱疹病毒和肝炎。通过打孔活检从左乳房采集的材料进行组织病理学检查显示角化不全、棘层肥厚以及真皮血管周围淋巴细胞浸润。基于临床、组织病理学和实验室检查结果，给予患者每日2g消胆胺及外用皮质类固醇治疗有效，该患者被诊断为妊娠肝内胆汁淤积症和妊娠性痒疹。据作者所知，这是文献中首例此类报道病例。
