[Polymorphic eruption of pregnancy, a differential diagnosis of severe reactions to medications]

Rev Alerg Mex. Jul-Sep 2019;66(3):366-370. doi: 10.29262/ram.v66i3.353.
[Article in Spanish]

Abstract

Background: The polymorphic eruption of pregnancy (PEP) is a pathology that usually occurs in the last trimester of pregnancy and it affects around 0.5% pregnancies. So far, it has not been associated to medications, but it could mimic any severe delayed reaction to drugs.

Clinical case: A woman with a clinical picture that suggests PEP during the last trimester of pregnancy. She was assessed by the allergy department, where it was viewed as PEP; however, the decision was to perform skin tests: skin prick tests, intradermal tests, and skin patch tests with drugs involved; all of which showed negative results.

Conclusions: Severe reactions to medications are a challenge for health professionals. In acute management, the identification and suspension of the involved medication are the cornerstones of the treatment; however, many of the patients are polymedicated, which makes it difficult to identify the underlying cause. An allergy assessment is recommended as part of the optimal multidisciplinary management of each patient in order to identify the substance that is involved as the cause of the disease and, therefore, to avoid unnecessary restrictions.

Antecedentes: La erupción polimorfa del embarazo es una patología que se presenta normalmente en el último trimestre de los embarazos y afecta aproximadamente a 0.5 % de las mujeres en esta condición. No se ha relacionado con medicamentos, pero podría imitar cualquier reacción grave por medicamentos tardías. Caso clínico: Mujer con cuadro clínico sugestivo de erupción polimorfa del embarazo durante el último trimestre del embarazo. Fue valorada por alergología, donde se consideró erupción polimorfa del embarazo, sin embargo, se decidió realizar pruebas cutáneas: punción cutánea, pruebas intradérmicas y prueba de parche con medicamentos implicados, todas con resultados negativos. Conclusiones: Las reacciones graves por medicamentos son un reto para el profesional de la salud. En el manejo agudo, la identificación y suspensión del medicamento implicado son la piedra angular del tratamiento, sin embargo, numerosas pacientes están polimedicadas, lo que dificulta identificar la causa subyacente. Es recomendable una valoración por alergología como parte del manejo multidisciplinario óptimo de cada paciente, con el fin de lograr detectar la sustancia implicada como causal de la enfermedad y evitar restricciones innecesarias.

Keywords: Adverse reaction to medications; Papules; Polymorphic eruption; Pregnancy; Pruritic plaques; Urticarial lesions.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Diagnosis, Differential
  • Drug Eruptions / diagnosis*
  • Female
  • Humans
  • Pregnancy
  • Pregnancy Complications / diagnosis*
  • Pruritus / diagnosis*
  • Severity of Illness Index

Supplementary concepts

  • Pruritic urticarial papules plaques of pregnancy