Primary dermatologic findings with early-onset intrahepatic cholestasis of pregnancy.
BACKGROUND
Primary dermatologic findings are not thought to be associated with intrahepatic cholestasis of pregnancy. We report on a patient with twins who presented with a pruritic rash and cholestasis.


METHODS
A woman with a twin gestation and two previous term stillbirths developed a pruritic rash at 16 weeks. Scleral icterus and jaundice were observed at 27 weeks. Elevated bile acid levels confirmed a diagnosis of intrahepatic cholestasis of pregnancy, and ursodeoxycholic acid therapy was initiated. Fetal heart rate decelerations were noted at 32 4/7 weeks, prompting delivery of two live male newborns. Declining laboratory values and resolution of rash occurred within a few days of delivery.


CONCLUSIONS
This case illustrates an unusual presentation of recurrent cholestasis of pregnancy in a twin gestation with primary dermatologic findings.
From the Department of Obstetrics and Gynecology, Maternal-Fetal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
Tamara T
TT
Chao
Jeanne S
JS
Sheffield
D001623:Betamethasone / Q000627:therapeutic use; D001647:Bile Acids and Salts / Q000097:blood; D002756:Cholagogues and Choleretics / Q000627:therapeutic use; D002780:Cholestasis, Intrahepatic / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy; D036861:Delivery, Obstetric; D005076:Exanthema / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006340:Heart Rate, Fetal; D006801:Humans; D006919:Hydroxyzine / Q000627:therapeutic use; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000188:drug therapy; D011537:Pruritus / Q000175:diagnosis* / Q000188:drug therapy; D016896:Treatment Outcome; D014221:Triamcinolone / Q000627:therapeutic use; D014427:Twins; D014463:Ultrasonography; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use; D055815:Young Adult
D001647:Bile Acids and Salts; D002756:Cholagogues and Choleretics; D005938:Glucocorticoids; D014221:Triamcinolone; D006919:Hydroxyzine; D014580:Ursodeoxycholic Acid; D001623:Betamethasone
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