Intrahepatic Cholestasis of Pregnancy Refractory to Multiple Medical Therapies and Plasmapheresis
نویسندگان
چکیده
Objectives We report on a patient suffering from intractable itching secondary to intrahepatic cholestasis of pregnancy (ICP) unresponsive to conventional medical therapies. She was started on a regimen of therapeutic plasma exchange (TPE), which is often efficacious in relieving patient's itching from all causes of cholestasis, including ICP. Methods We performed a retrospective review of a patient's medical record. Results Following initial TPE, the patient reported dramatic relief of her itching and consequent insomnia. However, this effect was short lived, as subsequent TPE provided minimal relief, and may have actually worsened her itching. Out of concern for poor fetal outcomes, delivery was induced at 34 weeks gestational age. The child had an uncomplicated neonatal intensive care unit stay following delivery, and the mother reported > 90% relief of her symptoms 2 weeks after delivery. Conclusion TPE often provides longer term relief of itching because of ICP; however, it is not a panacea for these symptoms, and sometimes only delivery of the fetus can relieve maternal symptoms. In addition to the refractoriness to TPE, the case is also unusual for the early onset of ICP symptoms and the comorbidity of hepatitis C.
منابع مشابه
Plasmapheresis in management of severe cholestasis of pregnancy
Introduction: Cholestasis of pregnancy usually presents with pruritus in the third trimester and it has good maternal prognosis. However, severe cholestasis can have a significant impact on the fetus leading to intrauterine death. Case Report: A 28-year-old female had severe cholestasis of pregnancy in first pregnancy, in second she developed pruritus and cholestatic liver function tests at 17 ...
متن کاملVariant adiponutrin confers genetic protection against cholestatic itch
Lysophosphatidic acid (LPA) mediates cholestatic pruritus. Recently the enzyme PNPLA3, expressed in liver and skin, was demonstrated to metabolise LPA. Here we assess the association of the PNPLA3 variant p.Ile148Met, known to be associated with (non-)alcoholic fatty liver disease (NAFLD) in genome-wide association studies, with cholestatic itch in 187 patients with primary biliary cirrhosis (P...
متن کاملManagement of Hepatic Cholestasis
Hepatic cholestasis is characterized by elevated alkaline phosphatase and gama - glutamyl transpeptidase levels which is then followed by conjugated hyperbilirubinemia. It is classified into intrahepatic and extrahepatic cholestasis. Intrahepatic cholestasis indicates hepatocellular dysfunction or the presence of an obstructive lesion in intrahepatic bile ducts distal to biliary canalicular sy...
متن کاملPlasmapheresis for Refractory Pruritus due to Drug-Induced Cholestasis
Pruritus can be a distressing symptom seen in various cholestatic disorders. It is treated with medications like bile acid sequestrants. Drug-induced cholestasis usually resolves with withdrawal of the causative medication. We describe a case of refractory pruritus due to drug-induced cholestasis, not improved with withdrawal of the drug, managed effectively with multiple sessions of plasmapher...
متن کاملNasobiliary Drainage for Benign Recurrent Intrahepatic Cholestasis in Patients Refractory to Standard Therapy.
PURPOSE Benign recurrent intrahepatic cholestasis (BRIC) is characterized by episodic cholestasis and pruritus without anatomical obstruction. The aim of this study was to evaluate the safety and efficacy of nasobiliary drainage (NBD) in patients with BRIC refractory to medical therapy and to determine whether the use of NBD prolongs the episode duration. METHODS This was a multicenter retros...
متن کامل