The NEW ENGLAND JOURNAL of MEDICINE CASE RECORDS of the MASSACHUSETT GENERAL HOSPITAL Founded by Richard C. Cabot Eric S.Rosenberg,M..,Editor Nancy Lee Harris, M.D., Editor Jo-Anne O. Shepard, M.D., Associate Editor Alice M. Cort, M.D., Associate Editor Sally H. Ebeling, Assistant Editor Emily K. McDonald, Assistant Editor Case 16-2016: A 31-Year-Old Pregnant Woman with Fever Dwight J. Rouse, M. D., Thomas W. Keimig, M.., Laura E. Riley, M.D., Alyssa R. Letourneau, M. D., M.P. H . and Mia Y. Platt, M.D., Ph.D. Xueping Yu and Jiming Zhang 2016.06.16
Xueping Yu and Jiming Zhang 2016.06.16
Presentation of case A 31-year-old primigravid woman Dichorionic twins At 35 weeks of gestation ° Complicated by iron 胎盘 羊膜囊2 胎膜隔 胎体2 deficiency anemia and 羊膜囊1 胎体1 yperemesIs 船胎盘2 Fever
Presenta(on of case • A 31-year-old primigravid woman • Dichorionic twins • At 35 weeks of gesta(on • Complicated by irondeficiency anemia and hyperemesis • Fever
Previous medical history() The sickle cell trait, gastroesophageal reflux disease, exercise-induced asthma dysmenorrhea, a stress fracture of her left tibia clostridium difficile infection after clindamycin use and pancreatitis ° Positive for rubella- specific antibodⅰes Negative for human immunodeficiency virus (HIV) and hepatitis b virus surface antigen (HBSAg)
Previous medical history(I) • The sickle cell trait, gastroesophageal reflux disease, exercise-induced asthma, dysmenorrhea, a stress fracture of her leJ (bia, clostridium difficile infec(on aJer clindamycin use and pancrea((s • Posi(ve for rubella-specific an(bodies • Nega(ve for human immunodeficiency virus (HIV) and hepa((s B virus surface an(gen (HBsAg)
Previous medical history(ll) She did not smoke tobacco drink alcohol or use illicit drugs She did not eat lunch meat or soft cheeses during pregnancy but noted that she consumed wellboiled hot dogs and frequently ate commercialbrand hummus Her father had had deep venous thromboses her husband did not carry the sicklecell trait Current medications were ursodiol iron polysaccharide, a prenatal vitamin, doxylamine for sleep, ranitidine, and an albuter
Previous medical history(II) • She did not smoke tobacco, drink alcohol, or use illicit drugs • She did not eat lunch meat or soJ cheeses during pregnancy but noted that she consumed wellboiled hot dogs and frequently ate commercialbrand hummus • Her father had had deep venous thromboses • her husband did not carry the sicklecell trait • Current medica(ons were ursodiol, iron polysaccharide, a prenatal vitamin, doxylamine for sleep, rani(dine, and an albuter
History of present illness o Approximately 3 weeks before this evaluation mild pruritus of the palms and soles Sixteen days before this evaluation at 32 weeks 5 days of gestation) afebrile no visible rash fetal activity both fetal hearts were heard on auscultation Laboratory test results are shown in Table 1. a spot urinalysis revealed trace protein a diagnosis of cholestasis of pregnancy was made and ursodiol was administered
• Approximately 3 weeks before this evalua(on – mild pruritus of the palms and soles • Sixteen days before this evalua(on (at 32 weeks 5 days of gesta(on) – afebrile, no visible rash, fetal ac(vity – both fetal hearts were heard on ausculta(on. – Laboratory test results are shown in Table 1. A spot urinalysis revealed trace protein. A diagnosis of cholestasis of pregnancy was made, and ursodiol was administered. History of present illness(I)