commentary case 3
TRANSCRIPT
![Page 1: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/1.jpg)
A pregnant woman with headache and
visual symptomsBy :
Prof. Dr. : Fawzy MegahedAss. Lec. : Mahmoud Negm
![Page 2: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/2.jpg)
A 30-year-old pregnant woman (gravida 2, para 0) was admitted to this hospital at 33 weeks of gestation because of headache and visual symptoms.
![Page 3: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/3.jpg)
The patient had been in her usual health until 2 weeks before admission, when neck
pain developed.
![Page 4: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/4.jpg)
Eleven days before admission, she was seen in the emergency department because of neck and back pain, occipital headache,
vomiting .
![Page 5: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/5.jpg)
On examination, the back was tender; the vital signs and remainder of the examination
were normal.
![Page 6: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/6.jpg)
Urinalysis revealed yellow, cloudy urine, with trace ketones, 1+ albumin, and 2+
urobilinogen .
![Page 7: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/7.jpg)
Paracetamol was prescribed, with some improvement. The patient was discharged home.
![Page 8: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/8.jpg)
The headache improved spontaneously after 3 days.
![Page 9: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/9.jpg)
At the time of presentation
![Page 10: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/10.jpg)
The patient felt the onset of a panic attack followed by tunnel vision; she began to hyperventilate and her vision went black from the periphery to
the center.
![Page 11: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/11.jpg)
The symptoms lasted for approximately 2 minutes and were followed by spots in her visual fields, headache, neck pain that radiated to her arms, nausea, and dizziness .
![Page 12: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/12.jpg)
The patient reported normal fetal movement and no fever, diarrhea, abdominal pain, vaginal bleeding, leaking fluid, or
contractions.
![Page 13: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/13.jpg)
During the third trimester, a glucose-tolerance test was positive. She had intermittent atypical chest pain that had lasted for several years .
![Page 14: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/14.jpg)
2.5 months before admission, an evaluation of the pain was done including ECG, which revealed non specific ST-segment and T-wave changes, and transthoracic echocardiography , which was
normal.
![Page 15: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/15.jpg)
3 years ago , she had presented at 20 weeks of gestation with sepsis and a stillborn fetus; dilation and evacuation had
been performed.
![Page 16: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/16.jpg)
She also has anemia (with a history of iron deficiency), asthma , and seasonal allergic rhinitis .
![Page 17: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/17.jpg)
She had undergone multiple laparoscopies , including cholecystectomy for cholelithiasis, lysis of adhesions , and ovarian
cystectomies.
![Page 18: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/18.jpg)
Medications included a prenatal multivitamin and ferrous sulfate.
![Page 19: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/19.jpg)
She did not smoke, drink alcohol, or use illicit drugs.
![Page 20: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/20.jpg)
Her mother had had breast cancer and died in her 50s.
![Page 21: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/21.jpg)
To summarize the case
![Page 22: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/22.jpg)
A 30 year old female presented in her 3rd trimester by headache , neck pain , nausea , vomiting and a panic
attack . She also has a histoey of anemia ,
atypical chest pain , asthma and allergic rhinitis .
Her previous pregnancy ended at 20th week by sepsis and stillborn fetus.
![Page 23: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/23.jpg)
On examination
![Page 24: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/24.jpg)
The temperature was 36.7°C, the blood pressure 117/68 mm Hg, the pulse 104 beats per minute, and the respiratory rate 18
breaths per minute.
![Page 25: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/25.jpg)
Her abdomen was gravid, soft, and nontender, with active fetal movements. The fetal heart rate tracing was
reassuring.
![Page 26: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/26.jpg)
There was no peripheral edema or abdominal tenderness. Reflexes were normal, as were the remaining general and neurologic examinations.
![Page 27: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/27.jpg)
The blood glucose level was 111 mg per deciliter . Blood levels of uric acid, magnesium, calcium, phosphorus, total protein, globulin, and total and direct bilirubin were
normal.
![Page 28: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/28.jpg)
The other test results are shown in the following
table .
![Page 29: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/29.jpg)
![Page 30: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/30.jpg)
![Page 31: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/31.jpg)
![Page 32: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/32.jpg)
![Page 33: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/33.jpg)
![Page 34: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/34.jpg)
![Page 35: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/35.jpg)
Intravenous fluids and acetaminophen–caffeine were administered, followed by prochlorperazine , and diphenhydramine; the patient’s condition partially improved.
![Page 36: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/36.jpg)
Magnetic resonance imaging (MRI) of the head could not be performed because of the
patient’s anxiety.
![Page 37: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/37.jpg)
After 24 hours, the patient’s symptoms had not resolved, and She reported severe occipital
headache .
![Page 38: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/38.jpg)
Later that day, MRI of the head was performed without the administration of contrast
material .
![Page 39: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/39.jpg)
The lesions were thought to reflect infarcts that had occurred at least 6 hours
earlier. A 48 hour follow up MRI was
done .
![Page 40: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/40.jpg)
![Page 41: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/41.jpg)
Results of magnetic resonance angiography and venography were normal. Ultrasonography of the legs revealed no evidence of DVT .
![Page 42: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/42.jpg)
To summarize the case
![Page 43: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/43.jpg)
A 30 year old female presented in her 3rd trimester by headache , neck pain , nausea , vomiting and a panic
attack . She also has a histoey of anemia ,
atypical chest pain , asthma and allergic rhinitis .
Her previous pregnancy ended at 20th week by sepsis and stillborn fetus.
![Page 44: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/44.jpg)
MRI is suggestive of multiple strokes. Laboratory work up revealed
abnormal CBC , dyslipidemia , abnormal levels of naturally occuring anicoagulant protiens , gestational diabetes and high CRP.
![Page 45: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/45.jpg)
What is your differential diagnosis?
![Page 46: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/46.jpg)
• Eclampsia with hypertensive encephalopathy• Ischemic strokes due to hypercoaguablity• Cardioembolism• Drug abuse• Viral encephalitis• Cerebral vasculitis• Other diagnosis ????
![Page 47: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/47.jpg)
What is your next step ?
![Page 48: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/48.jpg)
ECG showed sinus tachycardia at a rate of 108 beats per minute and nonspecific ST-segment and T-wave changes.
![Page 49: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/49.jpg)
Holter monitoring did not reveal an arrhythmia. A lumbar puncture was unsuccessful. Aspirin (81 mg daily), metoclopramide, and prenatal vitamins were administered.
![Page 50: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/50.jpg)
On the third day
![Page 51: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/51.jpg)
The PT , INR , and aPTT were normal, as were results of tests for factor VIII, partial-thromboplastin time – lupus anticoagulant, anticardiolipin
IgG and IgM antibodies.
![Page 52: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/52.jpg)
Results of tests for functional antithrombin III, functional protein C, activated protein C resistance, and prothrombin gene mutation were normal .
![Page 53: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/53.jpg)
Betamethasone was administered to promote fetal lung maturity. An active, well-grown fetus was seen on ultrasound examination. The patient’s headache resolved.
![Page 54: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/54.jpg)
The next day ……
![Page 55: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/55.jpg)
On evaluation by ophthalmology consultants, she reported no acute change in vision, eye pain, or eye redness, but she did have floaters, which she described as
“worms “.
![Page 56: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/56.jpg)
On examination, there was binocular horizontal diplopia (which could be relieved with the use of corrective lenses) and
a pterygium on the left side .
![Page 57: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/57.jpg)
No evidence of papilledema, embolic phenomena, or vasculitis on funduscopic
examination.
![Page 58: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/58.jpg)
Testing revealed antibodies to hepatitis A virus; screening for hepatitis B and C viruses was
negative.
![Page 59: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/59.jpg)
What to do next ?????
![Page 60: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/60.jpg)
On the fifth day, transthoracic echocardiography revealed a hyperkinetic left ventricle without wall-motion abnormalities and with obliteration of the left ventricular
cavity during systole.
![Page 61: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/61.jpg)
The right ventricular apex was akinetic and aneurysmal.
![Page 62: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/62.jpg)
In both ventricles, there was prominent accumulation of sessile, smooth-bordered endocardial material with an echodensity that was distinctly different from that of
the myocardium .
![Page 63: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/63.jpg)
Thus, the findings were suggestive of endocardial
deposits.
![Page 64: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/64.jpg)
![Page 65: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/65.jpg)
Tissue Doppler echocardiography, Doppler assessment of the transmitral flow velocity and pulmonary-vein flow velocity revealed that the left ventricular diastolic function was
normal.
![Page 66: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/66.jpg)
These echocardiographic findings are consistent with …………..
![Page 67: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/67.jpg)
LOFFLER’s ENDOCARDITIS
![Page 68: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/68.jpg)
![Page 69: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/69.jpg)
Let us revise our differential diagnosis
![Page 70: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/70.jpg)
• Hypereosinophilic syndrome• Parasitic infection• Churg–Strauss eosinophilic vasculitis• Chronic myelogenous leukemia• Mastocytosis with peripheral eosinophilia• Eosinophilia – myalgia syndrome• Hodgkin disease• Familial eosinophilia
![Page 71: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/71.jpg)
A continuous intravenous infusion of heparin was initiated.
![Page 72: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/72.jpg)
What to do next ?????
![Page 73: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/73.jpg)
Examination of the bone marrow–biopsy specimen revealed normal cellularity and maturing trilineage
hematopoiesis .
![Page 74: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/74.jpg)
![Page 75: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/75.jpg)
No iron was present on an iron stain.
![Page 76: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/76.jpg)
Results of conventional karyotype analysis, fluorescence in situ hybridization for the FIP1L1-PDGRFA, B-cell and T-cell clonality testing by means of PCR assay for an occult lymphoma, and quantitative BCR-ABL testing for
CML were all normal.
![Page 77: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/77.jpg)
What is your next step ?
![Page 78: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/78.jpg)
A stool examination for ova and parasites was
negative .
![Page 79: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/79.jpg)
ELISAs for antibodies against schistosoma sp. , ascaris lumbercoides ,entrobius vermicularis , trichinella and toxocara species were negative .
![Page 80: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/80.jpg)
ELISAs for antibodies against Strongyloides stercoralis was positive .
![Page 81: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/81.jpg)
Diagnosis ??????
![Page 82: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/82.jpg)
Embolic strokes due to Loffler’s endocarditis, which was most likely caused by helminthic infection ( strongyloidiasis) , with secondary hypereosinophilic
syndrome.
![Page 83: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/83.jpg)
Eosinophilia Definition :"Persistent" eosinophilia is blood eosinophilia on 2 occasions, at least one month apart .Blood eosinophil count 1500 cells/mm3 is classically considered the level above which organ damage is more likely to occurNote that tissue eosinophilia with potential for organ damage may be present with a normal blood eosinophil count, and vice versa.
![Page 84: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/84.jpg)
Classification Blood absolute eosinophil count (/mm3)
<500( often <5% of leukocytes)
Normal healthy patient
>500 Eosinophilia
>1500 Hypereosinophilia
>5000 Severe (or Massive)
![Page 85: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/85.jpg)
![Page 86: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/86.jpg)
![Page 87: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/87.jpg)
![Page 88: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/88.jpg)
![Page 89: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/89.jpg)
![Page 90: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/90.jpg)
Management of the case
![Page 91: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/91.jpg)
Initially, delivery was deferred to avoid a preterm birth and to allow time for treatment to improve the patient’s cardiac and neurologic function and reduce the clot
burden in the left ventricle.
![Page 92: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/92.jpg)
• In this case, the reasons to administer glucocorticoids, include maturation of the fetal lungs and the hypereosinophilic
syndrome . • Insulin was administered to maintain
euglycemia.
![Page 93: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/93.jpg)
A cesarean delivery was performed in the main operating room with the patient receiving an epidural anesthetic. A viable male infant was delivered, with a weight of 2960 g and Apgar scores of 7 and 8 at 1 and 5
minutes, respectively.
![Page 94: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/94.jpg)
Albendazole and ivermectin are pregnancy category C drugs . Albendazole was administered only after the baby was delivered. We thought that the administration of ivermectin could not wait until after delivery because of the potential
risk of disseminated strongyloides.
![Page 95: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/95.jpg)
She was discharged on the 14th hospital day; she took a planned 3-week course of albendazole and a tapering course of glucocorticoids. Warfarin was given for 6 months, and oral and parenteral iron were administered for iron deficiency anemia.
![Page 96: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/96.jpg)
The eosinophilia had resolved by the time of discharge and did not recur. The echocardiographic abnormalities had resolved almost completely within 6 weeks after discharge, and more than 3 years later, the patient remains well. Her child is healthy.
![Page 97: commentary case 3](https://reader036.vdocuments.mx/reader036/viewer/2022062503/5881c7cf1a28aba36a8b46cf/html5/thumbnails/97.jpg)
Thank you