PUPPP: Demonstration of Deranged Liver Enzymes during Pregnancy

Abstract

PUPPP, a Polymorphic Eruption of Pregnancy (PEP), is a chronic hives-like rash that strikes some women during pregnancy. The condition typically develops in the third trimester of pregnancy or immediately in the postpartum period. Clinically, it appears as an intensely pruritic (itchy) rash consisting of raised, edematous areas of small papules coalescing into larger plaques. The case report concerns a primigravida woman (period of gestation – 36 weeks) diagnosed with pruritic urticarial papules and plaques of pregnancy (PUPPP). She had been married since 10 months and this is her first pregnancy. The patient was admitted to labor room of Hakeem Abdul Hameed Centenary (HAHC) Hospital, New Delhi, with chief complaints of fever since 2 days, cellulitis since 7 days. During physical examination, rashes were seen on the face, abdomen and legs. Per abdomen examination revealed cephalic presentation of the fetus with FHR as 142 bpm. Routine blood investigations revealed that the patient had gestational hypertension (albumin trace in urine) and the serum bilirubin total was also raised (1.58 mg/dL). The Liver Function Test (LFT) results were, SGOT (200 IU/L), SGPT (144 IU/L) and ALP (262 IU/L). After all the required investigations, she was diagnosed with PUPPP with GHTN.