Konnataler intermittierender AV-Block III° nach Retinoideinnahme in der Schwangerschaft

Zusammenfassung

Hintergrund: Das Retinoid Acitretin ist zur Behandlung schwerer Verhornungsstörungen zugelassen. Acitretin ist erwiesenermaßen teratogen und führt bei Exposition im ersten Trimenon zu Fehlgeburten und unterschiedlichen Fehlbildungen einschließlich solcher des Herzens. Reizleitungsstörungen wurden bisher nicht beschrieben.

Fallbericht: Eine 24-jährige Frau wurde wegen einer Dyskeratosis follicularis (M. Darier) bis zur Woche 12 einer vorher nicht bemerkten Schwangerschaft mit Acitretin behandelt. Nach einer Gestationsdauer von 35 5/7 Wochen wurde wegen anhaltender fetaler Bradykardien bei tachykarder Grundfrequenz ein lebensfrisches, eutrophes Mädchen durch Kaiserschnitt geboren (Apgar 9/10/10), bei dem sich alsbald intermittierend ein AV-Block III° zeigte. Maternale Lupus- oder Sjögren-Antikörper ließen sich nicht nachweisen, serologisch bestand kein Anhalt für eine virale Myokarditis.

Schlussfolgerung: Das Spektrum der Retinoid-Embryofetopathie scheint auch Störungen des kardialen Reizleitungssystems zu umfassen.

Abstract

Background: The retinoid acitretin, which has been approved as an effective therapy for severe keratinization disorders, is highly teratogenic, and exposure in the first trimester of pregnancy is associated with the risk of miscarriage and various malformations, including congenital heart defects. Cardiac conduction system disorders have not been described so far.

Case report: A 24-year-old woman was treated with acitretin for dyskeratosis follicularis until pregnancy was diagnosed at 12 weeks of gestation. The female infant was born after 35 weeks gestation by cesarean section because of intermittent fetal bradycardia. The baby was vigorous at birth (Apgar 9, 10, 10 at 1, 5 and 10 min) but displayed intermittent third-degree atrioventricular block. A search for maternal autoantibodies and viral infections gave negative findings.

Conclusion: The spectrum of disorders caused by intrauterine retinoid exposure appears to include atrioventricular conduction failure.

Schlüsselwörter

Retinoide - Acitretin - Schwangerschaft - Dyskeratosis follicularis - Morbus Darier - konnataler AV-Block

Key words

retinoid - acitretin - pregnancy - dyskeratosis follicularis - Darier disease - congenital atrioventricular block

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