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Case Report: Multidisciplinary peripartum management of diffuse capillary-malformation-like lesions with
ZhiGao Pei1, YanFang He1, ShuBo Zhang1
1Department of Anesthesiology, Affiliated Hospital of North China University of Science and Technology, Tangshan, China.
Diffuse capillary-malformation-like cutaneous lesions are uncommon during pregnancy, and their clinical implications become more complex when they coexist with focal neurological symptoms or cerebrovascular malformation. This case report describes a 25-years-old primigravida admitted at 36 + 6 weeks of gestation with diffuse congenital capillary-malformation-like skin lesions, a documented history of cerebrovascular malformation diagnosed 10 years earlier, obesity, and hypothyroidism. Physical examination revealed extensive dark red to violaceous patches over the face, trunk, back, buttocks, and extremities. Brain imaging showed mild volume reduction and sulcal widening in the left temporoparietal-occipital region, a left frontal ischemic lesion, and non-visualization of most of the left posterior cerebral artery, whereas magnetic resonance venography revealed no obvious abnormality. After multidisciplinary assessment by obstetrics, anesthesiology, neurology, neurosurgery, and endocrinology, the patient underwent elective cesarean delivery at 37 + 0 weeks under an individualized staged anesthetic strategy. Maternal oxygenation and hemodynamics were maintained within an acceptable range, fetal exposure to general anesthetic agents before delivery was minimized, and no perioperative neurological event occurred. A healthy female neonate was delivered with Apgar scores of 10 at 1, 5, and 10 min. This case illustrates that diffuse capillary-malformation-like cutaneous lesions may serve as a clinical clue prompting broader vascular and neurological assessment when they coexist with neurological symptoms, documented cerebrovascular malformation, or abnormal neuroimaging. It also highlights the importance of descriptive terminology, individualized peripartum risk assessment, and multidisciplinary planning under diagnostic uncertainty.
Diffuse capillary-malformation-like cutaneous lesions are uncommon during pregnancy, and their clinical implications become more complex when they coexist with focal neurological symptoms or cerebrovascular malformation. This case report describes a 25-years-old primigravida admitted at 36 + 6 weeks of gestation with diffuse congenital capillary-malformation-like skin lesions, a documented history of cerebrovascular malformation diagnosed 10 years earlier, obesity, and hypothyroidism. Physical examination revealed extensive dark red to violaceous patches over the face, trunk, back, buttocks, and extremities. Brain imaging showed mild volume reduction and sulcal widening in the left temporoparietal-occipital region, a left frontal ischemic lesion, and non-visualization of most of the left posterior cerebral artery, whereas magnetic resonance venography revealed no obvious abnormality. After multidisciplinary assessment by obstetrics, anesthesiology, neurology, neurosurgery, and endocrinology, the patient underwent elective cesarean delivery at 37 + 0 weeks under an individualized staged anesthetic strategy. Maternal oxygenation and hemodynamics were maintained within an acceptable range, fetal exposure to general anesthetic agents before delivery was minimized, and no perioperative neurological event occurred. A healthy female neonate was delivered with Apgar scores of 10 at 1, 5, and 10 min. This case illustrates that diffuse capillary-malformation-like cutaneous lesions may serve as a clinical clue prompting broader vascular and neurological assessment when they coexist with neurological symptoms, documented cerebrovascular malformation, or abnormal neuroimaging. It also highlights the importance of descriptive terminology, individualized peripartum risk assessment, and multidisciplinary planning under diagnostic uncertainty.
