A 24-year-old patient with a history of psoriasis under control since she was 12 years old; obstetric formula G2P1A0.
During her first pregnancy, IH was diagnosed, which ended at 32 weeks due to intrauterine fetal death, apparently due to metabolic disturbance due to base condition or intolerance to carbohydrates secondary to high-dose corticotherapy.
During the postpartum period, the dermatological condition returned to normal.
The patient developed reactive adaptive personality disorder (anxiety-depressive syndrome) in the postpartum period.
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The patient was in her second pregnancy, presenting since the 16th week of gestation a clinical picture characterized by progressive compromise of the general state, fever, arthralgias and erythematous dermal plaques, scaly evolution and rapidly pustular painful extremities.
Evaluated with dermatologists, it was concluded that the clinical picture was compatible with HAI, which was confirmed by skin biopsy that described an epidermis with evidence of regular elongation of hypnotic ridges PAS intrapapillary colony.
Vasodilation and local accumulation of neutrophils and lymphocytes were observed in dermis.
Histopathological report concluded psoriasiform dermatitis compatible with IH.
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Ultrasonography revealed a single fetus with normal anatomy, growing in 50th percentile for gestational age, oligohydroamnios and doppler study of maternal-fetal territory within normal limits.
Treatment was initiated with systemic glucocorticoids (prednisone 60 mg/day), topical therapy and support measures to correct tendentious lesions, electrolyte imbalance and hypoalbuminemia.
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The patient had a partial regression of skin lesions and normalized the volume of liquidninic, presenting at 27 weeks of gestation erythrodermia intense exfoliation and arthralgias, cyclosporine therapy with prednisone at a dose of 2 mg/dl, his symptoms of metabolism decreased.
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Due to the severe deterioration of the basic psychiatric condition, it was decided to interrupt pregnancy at 34 weeks, by discharge, obtaining a male newborn, suitable for gestational age (2,680 grs) and five minutes with APGAR.
A few days after delivery, the patient presented total regression of the skin lesions.
Cyclosporine and prednisone doses were gradually reduced and completely withdrawn six weeks after delivery.
