Diagnostic Pitfall in Atypical Febrile Presentation in a Patient with a Pregnancy-Specific Dermatosis—Case Report and Literature Review

Abstract

Pruritic urticarial papules and plaques of pregnancy (PUPPP) usually occurs in the third trimester of pregnancy in primiparous women. It is a self-limiting inflammatory disorder with a still unknown pathogenic mechanism. The abdominal wall overdistension, with a subsequent inflammatory response due to damage to the connective tissue, represents a pathogenesis explanation. Clinical features involve intensely pruritic urticarial rash with edematous, erythematous papules and plaques. The clinical picture and dermal biopsy establish the diagnosis. Topical corticosteroids and oral antihistamines are usually sufficient, but sometimes systemic corticosteroids are necessary. Maternal and fetal prognosis is excellent, and the lesions resolve after birth with no scarring or pigmentary change. We present a case of a 36-year-old patient with a 32-week pregnancy who was admitted with a generalized pruritic rash accompanied by fever. The final diagnosis was decided after multiple pathology exclusions. Treatment consisted of systemic corticoid therapy. The patient gave birth by cesarean section to a healthy newborn without dermatological lesions or other conditions. Adding more PUPPP cases to the literature portfolio will bring more awareness to this under-recognized and under-reported skin disorder. We trust this case will encourage other physicians to publish more cases of pregnancy-specific dermatoses.

Research Trend of Studies Regarding the Change and Treatment of the Skin on Pregnant Women in the Last Decade: A Systematic Review and Bibliometric Analysis

“…Some literature also reported that the publication of studies related to complement therapy to reduce nausea and vomiting during pregnancy sharply increased in the period 2007-2017. 7,8 Firstly, the top five most influential documents from studies regarding the change and treatment of the skin in pregnant women are shown in Table 1.…”

“…This shows that the number of citations per year on the document was stated to be 36.78, which it means that the document is cited an average of nearly 37 times every year from 2014 into 2022. Some documents with numerous citations studied complementary therapy to reduce nausea and vomiting during pregnancy, 7 the effect of aromatherapy on nausea and vomiting in pregnant women, 8 and the psychologic changes in pregnant women. 4 This shows that these documents have made the most contribution to the changes in pregnant women.…”

“…Several literature studies related to pregnant and lactating women, for example, the literature review: complementary therapy to reduce nausea and vomiting during pregnancy, 7 effect of aromatherapy on nausea and vomiting in pregnant women (systematic review), 8 and a diagnostic pitfall in an atypical febrile presentation in a patient with a pregnancy-specific dermatosis-case report and literature review. 9 Literature research related to changes in pregnant women only, such as physiologic changes of pregnancy: A review of the literature stated that most clinicians recognize the changes that are usually described in the literature, such as 2ulfil2gmentation, melasma, striae gravidarum, and telogen effluvium.…”

An Overview of Cytomegalovirus Infection in Pregnancy

“…The associated septic symptomatology, hepatosplenomegaly, impaired liver function, pneumonia, hemolytic anemia, thrombocytopenia, and lymphocytosis have a mortality of up to 20% and serious long-term sequelae. Antiviral therapy decreases the viral load and associated organ disease [ 104 , 105 ].…”

Update on specific dermatoses of pregnancy

“…The papules can converge, forming plaques and extending to the limbs, trunk, and buttocks, protecting the mucous membranes and face ( Figure 1 ). They may exhibit small vesicles, target lesions, and polycyclic papules 14 , 22 . Generally, the condition persists for 4–6 weeks 4 .…”