Question-------------------------
Followup To
Question -
Hi,
My daughter, 32, is in her 13 week of her second pregnancy. Last Sunday, she suddenly got a rash on her breasts and abdomen and was very itchy. Her OB finally saw her on Tuesday and didn't really know what it was, but took blood tests. He said it would take about a week to come back, but on Thursday he called with the results. All her liver functions are fine EXCEPT for the bio-acid test. It came back 35. 4x higher than normal, but he still wasn't sure the rash was connected. She went to a gastro doctor who also said he wasn't sure the rash was related, and didn't understand why her bio-acid levels were high and the others weren't. He sent her for a sonogram and ultrasound of the abdomen and the results came back that the gall bladder/bile ducts had no blockage, but her pancreas was enlarged and she had a spot on her liver. We knew about this spot 2 years ago as it is a hemangioma as I have several of them on my liver too. He is sending her next week to a dermatologist and for a special MRI of the liver etc. He said he wasn't concerned about the enlarged pancreas because sometimes when you are pregnant things like that happen. She has no other uncomfortable symptoms other than this horrible rash which is now going all over the rest of her body and the itch is terrible. She is allergic to steroids, so she can't take them and the doctor prescribed last night Hydroxyzine which we read isn't good for the baby. She was taking benedryl, but it wasn't helping either. No other topical over the counter cream, no bath stuff has been helping either. She moved to Charlotte, NC from NY last year so I am not even near to help. I feel terrible for her and she is climbing the walls. We are worried that it might be Cholestasis, but the symptoms other than the bio-acid levels don't match. PUPPS seems to come at a much later stage of pregnancy too.
Do you have any ideas and should we worry about this bio-acid level? I also read which I didn't tell her that high bio-acid levels can mean breast cancer or colon cancer. Is this true and if so should I tell her and make her more crazy than she is?
Thank you and hoping to hear from you ASAP!
Sherry Reiver
Answer -
PUPPS occurs later on in preganncy. Any time that a patient complains of severe itching during pregnancy, she needs a full workup to rule out liver disease or cholestasis of pregnahcy. I'm sure that the GI doctor and her obstetrician are working on that. I would continue to use Benadryl (50mg every four hours) to relieve the itching. I really doubt that bio-acid levels are a marker for Cancer (I have not seen any reference to that). As long as the fetus is growing and there is no obstetrical problem right now, there is nothing more to do. She should definitely see the dermatologist. I'm sure that the dermatologist can diagnose and treat the rash. Be patient. Good Luck.
Hello again,
Thought I could follow up with what we know so far! Three doctors including you didn't think it was PUPPS! The biopsy of one of the spots that the derm. took off turned out to be PUPPS. He doesn't know why her bio-acids are high and neither does the OB or the Gastro drs. They took more blood on Tues. but she hasn't gotten the results yet. They also gave her an MRI without contrast and it only showed 2 hemangiomas when the abdominal sonogram showed MANY. They said because there was no contrast it was probably not the best test, but she can't have the contrast while pregnant. The derm. gave her some very thick cream on Monday and it seemed to help, but he feels she may get another flair-up again after she stops the cream. As I said before she CANNOT take internal steroid medicine. We are all concerned about the high bio acid levels because that can harm the baby, but they said PUPPS doesn't. Is there any chance she has both PUPPS and that cholestasis thing? Anything is possible since no one thought it was PUPPS to begin with!
Thanks again and hope to hear from you soon.
Sherry Reiver
AnswerIf a biopsy found one focus of PUPPS, then your daughter definitely has PUPPS. However, that does not exclude the possibility of another, concommittent, problem. The dermatologist will have to come up with a method of alleviation of her symptoms without compramizing her allergies or interfering with the pregnancy. Since I have no idea of what else it can be, I do not wish to mislead you with any suppositions.
