ABSTRACT
There are more than 150,000 new cases of coccidioidomycosis annually in the United States and the incidence is increasing. Although the majority of cases result in mild or no symptoms, pregnancy is a risk factor for complicated and disseminated disease. Overall, coccidioidomycosis is rare in pregnancy and there have been few reports in the literature of dissemination into the placenta. This report describes a 31-year-old primigravida with coccidioidomycosis diagnosed by placental examination. In retrospect, she had mild symptoms in the antepartum period but otherwise had no immediate complications due to the infection apart from the adhesive pelvic disease. The clinician should have a high index of suspicion for coccidioidomycosis in a pregnant woman presenting with a persistent respiratory illness who resides in, or who has recently recent travelled to, an endemic area. Additionally, a diagnosis of disseminated coccidioidomycosis should be considered for a woman with adhesive pelvic disease residing in an endemic region and one should consider microscopic placental examination if these findings are noted at cesarean delivery.
ABSTRACT
Paroxysmal nocturnal hemoglobinuria (PNH) is a rare disease caused by mutations in hematopoietic stem cells leading to pancytopenia and a predisposition for thromboembolic events. In pregnancy, these manifestations can be amplified, leading to increased neonatal and maternal morbidity and mortality. Although data are limited, eculizumab has emerged as a potential treatment of PNH in pregnancy. This report describes a case of a woman with PNH successfully treated with eculizumab during two pregnancies. Although during both pregnancies she experienced breakthrough hemolysis requiring intermittent blood transfusions, she had no thromboembolic events and had term vaginal births. Granted more research is needed, eculizumab may be an acceptable therapy for PNH in pregnancy.
ABSTRACT
Although ectopic breast tissue is rare in the general population, it is important to consider when investigating an axillary or vulvar mass. Ectopic breast tissue most commonly occurs postpartum but is not exclusive to that period. We report the case of a 29-year-old woman with ectopic breast tissue in multiple sites, including the axilla and vulva. The patient initially presented with a painless right axillary mass; it was excised and diagnosed as a fibroadenoma. She was then diagnosed with fibroadenoma of the vulva four years later. While ectopic breast tissue is most commonly found in the postpartum period it can occur outside of pregnancy. Therefore it should be included in the differential diagnoses for axillary or vulvar masses. Additionally, it is important to monitor women with ectopic breast tissue, particularly in the vulva, for recurrence.
