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Labor epidural placement in a 35 year old parturient with Sézary syndrome
Abstract Number: RF4AD-411
Abstract Type: Case Report Case Series
Sézary Syndrome is an aggressive form of cutaneous T-Cell leukemia. Mycosis fungoides and Sézary syndrome represents a spectrum of cutaneous T-cell lymphoma. The clinical manifestation consists of flat patches that may evolve into raised, infiltrated plaques and nodules with involvement of lymph nodes and the viscera. Patients present with erythroderma, lymphadenopathy and leukemic evidence in the peripheral blood. Other common signs of the condition consist of alopecia, intense pruritus of the lesions (1). It was first reported in a case report by Dr. Sézary, a French dermatologist in 1938 (2). Although Sézary syndrome can affect patients of any age, it is commonly seen in patients age 50 and over. Advanced disease carries a poor prognosis, with median survival years averaging 3.8 years.
A 35 year-old G5P3A2 with a history of Stage IV Sézary Leukemia with plaques and lymph nodes involvement, presented with contractions. Patient was diagnosed a year ago with Sézary leukemia, but she has been noncompliant with the recommendations from her dermatologist and oncologist. She has not received any treatment since her diagnosis. Upon presentation to Labor and delivery, she had diffuse pruritis, hypopigmented lesions on upper extremities, face, lower extremities. No visible lesions noted in the trunk. She was evaluated by MFM and a trial of labor was started with Misoprostol. After thorough assessment and discussion with the patient, specifically risks of infection and potential spread of malignant cells into epidural or intrathecal space, the patient decided to proceed with epidural placement and had an uncomplicated vaginal delivery.
Sézary syndrome is a rare condition encountered during pregnancy. Research on the safety of the placement of neuraxial anesthesia is scarce in the literature. A particular concern is the spread of malignant cells systemically through the epidural space or intrathecally. We were able to find one case report in the literature of a patient with Sézary syndrome who received neuraxial anesthesia without any complications (3).
A careful physical exam and review of patient chart has to be performed before the decision of placement of neuraxial anesthesia. Any lesions over the area of needle insertion should preclude neuraxial anesthesia and concerns should be addressed with patient and obstetrical team.
1.Leukemia & Lymphoma. 59(3):562-577, 2018 03.
2.JAMA Dermatology. 154(4):496-497, April 2018.
3.Anesthesia 2002 Aug;57(8): 836-7