Herpes simplex virus associated erythema multiforme in a prepartum woman without involvement of the newborn

Dilation and evacuation for fetal demise in a patient with presumed erythema multiforme major: A case report

Background

Erythema multiforme is a rare dermatologic condition. There is limited data on the effects of erythema multiforme on the vulva, vagina, and pregnancy.

Case

This case report describes a 32-year-old woman with erythema multiforme major with vulvovaginal involvement, found to have a fetal demise measuring 16 weeks' gestation. Dilation and evacuation was performed and was complicated by vaginal adhesions. The adhesions were lysed intraoperatively and managed postoperatively with vaginal dilators and topical corticosteroids for three months. At six weeks postoperatively, the vulvovaginal lesions had completely healed with no residual scarring or stenosis.

Conclusion

Erythema multiforme with vulvovaginal involvement can complicate obstetrical procedures and requires a multidisciplinary approach. In this instance, pain control, topical corticosteroids, and vaginal dilators produced favorable clinical outcomes.

Toxic epidermal necrolysis in pregnancy: case report and review of the literature

The authors report the case of a 29-year-old pregnant woman (2g1p) in the 16th week of gestation presenting with extensive toxic epidermal necrolysis (TEN). The cutaneous symptoms began at hands, feet, and in the mouth and developed during the course of 10 days to cover 75% of her TBSA, whereas total epidermolysis was present on more than 40% of her TBSA. Because of progressive swelling and bleeding of the oral mucosa, tracheal intubation was necessary to secure the airway of the patient. Critical care management required sedation, tracheotomy and artificial ventilation (14 days), prolonged fluid resuscitation, daily wound care, topical antiseptic and systemic antibiotic medication, hemostatic therapy and blood transfusion, hypercaloric nutrition, and frequent obstetric ultrasound evaluations. Reepithelialization began simultaneously with progressive epidermolysis and was completed after 35 days of conservative treatment. Because the patient experienced a swollen vulva and a stenotic birth channel, typical sequelae of TEN, a primary cesarean section was required after 40 weeks of gestation. The male infant showed neither signs of skin detachment nor sequelae caused by the prolonged therapy for the mother. A multidisciplinary approach and appropriate medical infrastructure are required to solve the challenge of TEN in pregnancy. In addition, the particular role of gestation in the pathophysiology of TEN needs to be explored further.

Miscellaneous diseases affected by pregnancy

Miscellaneous groups of dermatoses are associated with pregnancy and affected by gestation, but they do not coincide with any known classifications. They are inflammatory in nature and include psoriasis, acne, hidradenitis suppurativa, atopic dermatitis, and erythema multiforme. Such dermatoses can either improve or worsen during pregnancy. This review focuses on the changes that can occur during the pregnant state.