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First report of decidual cast: case report A large decidual cast occurred in a 13-year-old girl undergoing treatment with ethinylestradiol/norgestimate for adolescent menorrhagia. Following hospitalisation and diagnosis with menorrhagia, the girl was commenced on two tablets of oral ethinylestradiol 35µg/norgestimate 0.25mg three times daily, with tranexamic acid and cotrimoxazole [trimethoprim/sulfamethoxazole]. The dosage of ethinylestradiol/norgestimate was then reduced from six tablets/24 hours on day 2, to two tablets/24 hours on day 4. The next day, one tablet per day was given with iron supplementation. She was discharged after 5 days in hospital, and advised to continue ethinylestradiol/ norgestimate for two cycles without a break. Twenty-five days later, she presented with severe abdominal pain and moderate bleeding. She then discharged a decidual cast measuring 10 × 9 × 2cm, in the shape of a uterine cavity. Extensive decidual transformation of the endometrial stroma was observed on pathology. There were suppurative and necrotic foci and the glandular epithelium showed atrophy. The girl was advised to complete the ethinylestradiol/ norgestimate regimen, and then allow a withdrawal bleed. Four weeks later, all examinations were normal. Torres A, et al. A case of unusual course of adolescent menorrhagia: decidual cast as a side effect of treatment. Fertility and Sterility 92: 1748e5-1748.e7, No. 5, Nov 801158320 2009 - Poland

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Editorial comment: A search of AdisBase, Medline, Embase and the WHO ADR database did not reveal any previous case reports of decidual cast associated with ethinylestradiol/norgestimate.

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Reactions 9 Jan 2010 No. 1283