Primary dermatologic findings with early-onset intrahepatic cholestasis of pregnancy

Primary dermatologic findings are not thought to be associated with intrahepatic cholestasis of pregnancy. We report on a patient with twins who presented with a pruritic rash and cholestasis.

A woman with a twin gestation and two previous term stillbirths developed a pruritic rash at 16 weeks. Scleral icterus and jaundice were observed at 27 weeks. Elevated bile acid levels confirmed a diagnosis of intrahepatic cholestasis of pregnancy, and ursodeoxycholic acid therapy was initiated. Fetal heart rate decelerations were noted at 32 4/7 weeks, prompting delivery of two live male newborns. Declining laboratory values and resolution of rash occurred within a few days of delivery.

This case illustrates an unusual presentation of recurrent cholestasis of pregnancy in a twin gestation with primary dermatologic findings.