Autoimmune Progesterone Dermatitis With Angioedema Caused by Exogenous Progesterone in a Pregnant Woman: A Case Report

Authors

1 Department of Emergency Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

2 Department of Psychiatry, Tabriz University of Medical Sciences, Tabriz, Iran

3 Honorary Fellow Research, Aberdeen Biomedical Imaging Centre, Aberdeen University, Aberdeen, UK

Abstract

Background: Autoimmune progesterone dermatitis (APD) is an uncommon immunologic condition accompanied with dermatologic manifestations and caused by an immune response to endogenous or exogenous progesterone in women during their reproductive years. We report a case of APD in a pregnant woman who received exogenous progesterone to prevent preterm delivery.
 
Case Presentation: A 28-year-old female who was 17 weeks pregnant was referred to the emergency department with the complaint of progressive edema in the dorsal side of her right hand and progressive dyspnea. Intradermal skin test using 50 mg/mL progesterone resulted in 15 mm wheal in the injected area and approved the diagnosis of APD.
 
Conclusions: Patients with APD may have very different symptoms requiring immediate care; therefore, being informed about this condition is necessary for the physicians in emergency and obstetrics and gynecology departments. Also a positive history of such condition in a pregnant woman necessitates precautions in the management of her pregnancy due to the potential of anaphylactic events.

Keywords

Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

References

1. Géber H. Some information about the pathology of urticaria menstruationalis, [in German]. Dermatology. 1921;32(2-3):143-50.
https://doi.org/10.1159/000248242
 
2. Baptist AP, Baldwin JL. Autoimmune progesterone dermatitis in a patient with endometriosis: case report and review of the literature. Clin Mol Allergy. 2004;2(1):10.
https://doi.org/10.1186/1476-7961-2-10
PMid:15287986 PMCid:PMC509283
 
3. Snyder JL, Krishnaswamy G. Autoimmune progesterone dermatitis and its manifestation as anaphylaxis: a case report and literature review. Ann Allergy Asthma Immunol. 2003;90(5):469-77. 4. Bolaji ,I, O''Dwyer EM. Post-menopausal cyclic eruptions: autoimmune progesterone dermatitis. Eur J Obstet Gynecol Reprod Biol. 1992;47(2):169-71.
https://doi.org/10.1016/0028-2243(92)90050-9
PMid:1459332
 
4. Brooks GG. Anaphylactoid shock with medroxyprogesterone acetate: A case report. J La State Med Soc. 1974;126(11):397-9.
 
5. Meggs WJ, Pescovitz OH, Metcalfe D, Loriaux DL, Cutler GBJ, Kaliner M. Progesterone Sensitivity as a Cause of Recurrent Anaphylaxis. Obstet Gynecol Surv. 1985;40(6):372-3.
https://doi.org/10.1097/00006254-198506000-00018
 
6. Slater J, Kaliner M. Effects of sex hormones on basophil histamine release in recurrent idiopathic anaphylaxis. J Allergy Clin Immunol. 1987;80(3):285-90.
https://doi.org/10.1016/0091-6749(87)90033-9
PMid:2442235
 
7. Slater JE, Raphael G, Cutler GJ, Loriaux DL, Meggs WJ, Kaliner M. Recurrent anaphylaxis in menstruating women: treatment with a luteinizing hormone-releasing hormone agonist--a preliminary report. Obstet Gynecol. 1987;70(4):542-6.
https://doi.org/10.1097/00006254-198804000-00018
 
8. Bandino JP, Thoppil J, Kennedy JS, Hivnor CM. Iatrogenic autoimmune progesterone dermatitis caused by 17alpha-hydroxyprogesterone caproate for preterm labor prevention. Cutis. 2011;88(5):241-3.
 
9. Warin AP. Case 2. Diagnosis: erythema multiforme as a presentation of autoimmune progesterone dermatitis. Clin Exp Dermatol. 2001;26(1):107-8.
 
10. Kakarla N, Zurawin RK. A case of autoimmune progesterone dermatitis in an adolescent female. J Pediatr Adolesc Gynecol. 2006;19(2):125-9.
https://doi.org/10.1016/j.jpag.2006.01.050
PMid:16624703
 
11. Dedecker F, Graesslin O, Quereux C, Gabriel R, Salmon-Ehr V. Autoimmune progesterone dermatitis: a rare pathology. Eur J Obstet Gynecol Reprod Biol. 2005;123(1):120-1.
https://doi.org/10.1016/j.ejogrb.2005.03.007
PMid:16260344
 
12. Jenkins J, Geng A, Robinson-Bostom L. Autoimmune progesterone dermatitis associated with infertility treatment. J Am Acad Dermatol. 2008;58(2):353-5.
https://doi.org/10.1016/j.jaad.2007.10.646
PMid:18222339
 
13. Rodenas JM, Herranz MT, Tercedor J. Autoimmune progesterone dermatitis: treatment with oophorectomy. Br J Dermatol. 1998;139(3):508-11.
https://doi.org/10.1046/j.1365-2133.1998.02420.x
PMid:9767301
 
14. Schoenmakers A, Vermorken A, Degreef H, Dooms-Goossens A. Corticosteroid or steroid allergy? Contact Dermatitis. 1992;26(3):159-62.
https://doi.org/10.1111/j.1600-0536.1992.tb00286.x
PMid:1505180
 
15. Meltzer L. Hypersensitivity to gonadal hormones. South Med J. 1963;56:538-42.
https://doi.org/10.1097/00007611-196305000-00018
PMid:13934755
 
16. George R, Badawy SZ. Autoimmune progesterone dermatitis: a case report. Case Rep Obstet Gynecol. 2012;2012:757854.
https://doi.org/10.1155/2012/757854
PMid:22924142 PMCid:PMC3423662
 
17. Bierman SM. Autoimmune progesterone dermatitis of pregnancy. Arch Dermatol. 1973;107(6):896-901.
https://doi.org/10.1001/archderm.1973.01620210060016
PMid:4351124
 
18. Farah FS, Shbaklu Z. Autoimmune progesterone urticaria. J Allergy Clin Immunol. 1971;48(5):257-61.
https://doi.org/10.1016/0091-6749(71)90025-X
PMid:4398434
 
19. Georgouras K. Autoimmune progesterone dermatitis. Australas J Salari Rad M et al. 32 Razavi Int J Med. 2015;3(3):e29765 Dermatol. 1981;22(3):109-12.
https://doi.org/10.1111/j.1440-0960.1981.tb00039.x
PMid:7344688
 
20. Leech SH, Kumar P. Cyclic urticaria. Ann Allergy. 1981;46(4):201-3.
 
21. Hart R. Autoimmune progesterone dermatitis. Arch Dermatol. 1977;113(4):426-30.
https://doi.org/10.1001/archderm.1977.01640040034003
PMid:192155
 
22. Brestel E, Thrush L. The treatment of glucocorticosteroid-dependent chronic urticaria with stanozolol. J Allergy Clin Immunol. 1988;82(2):265-9.
https://doi.org/10.1016/0091-6749(88)91010-X
PMid:3403867
 
23. Shahar E, Bergman R, Pollack S. Autoimmune progesterone dermatitis: effective prophylactic treatment with danazol. Int J Dermatol. 1997;36(9):708-11.
https://doi.org/10.1046/j.1365-4362.1997.00105.x
PMid:9352418

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