Autoimmune Progesterone Dermatitis Mistaken for Stevens-Johnson Syndrome.

BACKGROUND: Autoimmune progesterone dermatitis is an uncommon disease presenting with cyclical skin eruptions corresponding with the menstrual cycle luteal phase. Because symptoms are precipitated by rising progesterone levels, treatment relies on hormone suppression. CASE: A 22-year-old nulligravid woman presented with symptoms mistaken for Stevens-Johnson syndrome. A cyclic recurrence of symptoms occurred, and the diagnosis of autoimmune progesterone dermatitis was made by an intradermal progesterone challenge. After 48 months, her disease remained refractory to medical management, and definitive surgical treatment with bilateral oophorectomy was performed. CONCLUSIONS: Autoimmune progesterone dermatitis is a challenging diagnosis as a result of its rarity and variety of clinical presentations. Treatment centers on suppression of endogenous progesterone and avoidance of exogenous triggers. When these modalities fail, surgical management must be undertaken.

Autoimmune Progesterone Dermatitis Presenting as Stevens-Johnson Syndrome.

BACKGROUND: Autoimmune progesterone dermatitis is an uncommon disease presenting with cyclical skin eruptions corresponding with the menstrual cycle luteal phase. Because symptoms are precipitated by rising progesterone levels, treatment relies on hormone suppression. CASE: A 22-year-old nulligravid woman presented with symptoms mistaken for Stevens-Johnson syndrome. A cyclic recurrence of her symptoms was noted, and the diagnosis of autoimmune progesterone dermatitis was made by an intradermal progesterone challenge. After 48 months, she remained refractory to medical management and definitive surgical treatment with bilateral oophorectomy was performed. CONCLUSION: Autoimmune progesterone dermatitis is a challenging diagnosis owing to its rarity and variety of clinical presentations. Treatment centers on suppression of endogenous progesterone and avoidance of exogenous triggers. When these modalities fail, surgical management must be undertaken.

Vitrification of oocytes produces high pregnancy rates when carried out in fertile women.

OBJECTIVE: To determine the efficiency of our vitrification technique when applied in young fertile women. DESIGN: Clinical research and application. SETTING: In vitro fertilization center. PATIENT(S): Twenty-one women were recruited from the navy community with 19 patients finishing the study. INTERVENTION(S): Vitrified oocytes with use of the electron microscopic grid method were warmed 6 months after vitrification. Surviving metaphase II oocytes were microinjected for fertilization, and clinical results were evaluated. MAIN OUTCOME MEASURE(S): Survival, fertilization, and cleavage rate. Pregnancy and implantation rate. RESULT(S): Three hundred ninety-five oocytes were warmed, of which 320 oocytes (81.0%) survived. Two hundred eighty-five metaphase II oocytes were microinjected for fertilization; 206 of them (72.3%) fertilized, and 53 embryos were transferred to 19 patients (in 20 warming cycles). Twenty-four of 53 transferred embryos (45.3%) implanted as confirmed by ultrasound examination. Of the 20 transfers, 16 resulted in clinical pregnancy (80%), 3 miscarried (15%), and 13 (65%) went on to produce 20 live births, respectively. This is much higher in comparison with our previous data using supernumerary oocytes where the rates of implantation and pregnancy were 6% and 21%. Live-birth rates per warmed oocyte and per injected oocyte were 5.1% and 7.2%, respectively. CONCLUSION(S): High pregnancy and implantation rates were observed after 6 months of cryopreservation by vitrification when oocytes from fertile woman were used. Proper screening of candidates for oocyte cryopreservation is of crucial importance to assure a favorable pregnancy outcome.