REPORT OF A CASE
A 26-year-old black woman, 15 weeks pregnant, presented with a six-week history of fatigue. She was found to have pancytopenia and splenomegaly and was referred to the Medical University of South Carolina, Charleston.On physical examination, marked hepatosplenomegaly, no peripheral lymphadenopathy, and a "slight hypopigmented rash" of the forearms and legs were found. Results of laboratory studies, including bone marrow biopsy, revealed an iron deficiency anemia and a pancytopenia consistent with hypersplenism. A chest computed tomographic scan showed massive hilar and mediastinal adenopathy suggestive of lymphoma. Abdominal ultrasound study confirmed the presence of hepatomegaly and massive splenomegaly. Fiberoptic bronchoscopy was performed and seven transbronchial biopsy specimens showed normal lung. Shortly thereafter, 1- to 4-mm hypopigmented pruritic papules were observed on the extensor aspects of the forearms, thighs, and legs (Fig 1). A skin biopsy was performed (Figs 2 and 3).What is your diagnosis?
Sahn EE. Pruritic White Papules in a Pregnant Woman. Arch Dermatol. 1987;123(11):1562A-1562B. doi:10.1001/archderm.1987.01660350176038