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  • Pregnant patient with extranodal CNS Rosai-Dorfman disease with new-onset seizures: the conundrum of differentiating disease progression from eclampsia

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Pregnant patient with extranodal CNS Rosai-Dorfman disease with new-onset seizures: the conundrum of differentiating disease progression from eclampsia
  1. Katie Swor1,
  2. Deepti Zutshi2,
  3. Elizabeth Dubey3 and
  4. Bernard Gonik1
  1. 1Obstetrics-Gynecology, Wayne State University, Detroit, Michigan, USA
  2. 2Neurology, Wayne State University, Detroit, Michigan, USA
  3. 3Emergency Medicine, Wayne State University, Detroit, Michigan, USA
  1. Correspondence to Dr Katie Swor; kswor{at}med.wayne.edu

Abstract

A 31-year-old woman at 30 weeks gestation presented to the emergency department following multiple seizures. Her history was significant for extranodal Rosai-Dorfman Disease (RDD) with central nervous system (CNS) lesions. RDD, a rare form of non-Langerhans cell histiocytosis, commonly presents with non-tender cervical lymphadenopathy. CNS involvement accounts for a small number of cases in those with extranodal disease. Patients with CNS RDD can have a variety of neurological symptoms, including seizures. Eclampsia, a relatively rare obstetric hypertensive disorder, is always within the differential diagnosis for patients presenting with late gestation seizures. We present the challenging evaluation and treatment of a patient whose clinical picture did not clearly differentiate eclampsia from new onset seizures related to progression of her RDD. This conundrum perhaps resulted in unnecessary preterm operative delivery of a critically ill patient. Only follow-up of the patient helped clarify the likely antepartum diagnosis.

  • pregnancy
  • epilepsy and seizures

https://doi.org/10.1136/bcr-2020-239427

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    Footnotes

    • Contributors KS participated directly in the patient’s clinical care, construction and editing of this manuscript as well as final approval of the document for publication. She accepts accountability for the article and will ensure that all questions regarding article accuracy and integrity are addressed and resolved. DZ participated in image formatting, construction and editing of this manuscript as well as final approval of the document for publication. He accepts accountability for the article and will ensure that all questions regarding article accuracy and integrity are addressed and resolved. ED participated directly in the patient’s clinical care, construction and editing of this manuscript as well as final approval of the document for publication. She accepts accountability for the article and will ensure that all questions regarding article accuracy and integrity are addressed and resolved. BG participated in construction and editing of this manuscript as well as final approval of the document for publication. She accepts accountability for the article and will ensure that all questions regarding article accuracy and integrity are addressed and resolved.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.