title: Deciduosis can cause remarkable leukocytosis and obscure abdominal pain.
abstract: Remarkable leukocytosis with obscure abdominal pain during pregnancy is clinically challenging for obstetricians. A 31-year-old pregnant woman developed persistently elevated white blood cell (approximately 30 000/µL) and C-reactive protein (3.0 mg/dL) with occasional moderate abdominal pain. At 29 gestational weeks, she underwent emergency cesarean section due to suspected abruptio placentae. Hemoperitoneum was observed with extensive hemorrhagic nodules on the peritoneal and omental surfaces. White blood cells rose 87200/µL, and C-reactive protein peaked at 44.9mg/dL after surgery. Pathologically, biopsies showed deciduosis, and decidual cells on the omental surface showed immunohistochemical staining for granulocyte colony-stimulating factor (G-CSF). Serum G-CSF concentration was 339 pg/mL at 28 weeks, and that of ascites was 312 000 pg/mL at cesarean section. G-CSF-producing deciduosis can induce leukocytosis as well as abdominal pain during pregnancy and postpartum.
authors.affiliation: Departments of Gynecology and Obstetrics Pathology, Kyoto University, Kyoto, Japan. kondo@kuhp.kyoto-u.ac.jp
authors.forename: Eiji
authors.initials: E
authors.lastname: Kondoh
authors.forename: Misao
authors.initials: M
authors.lastname: Shimizu
authors.forename: Kazuyo
authors.initials: K
authors.lastname: Kakui
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Mikami
authors.forename: Keiji
authors.initials: K
authors.lastname: Tatsumi
authors.forename: Ikuo
authors.initials: I
authors.lastname: Konishi
mesh_terms: D015746:Abdominal Pain / Q000209:etiology*; D000328:Adult; D005260:Female; D006801:Humans; D007964:Leukocytosis / Q000209:etiology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000276:immunology*