A case of herpes gestationis: Follow-up study of autoantibodies using enzyme-linked immunosorbent assay and immunoblotting

Abstract

1. Inui S, Nakao T, Itami S. Modulation of androgen receptor transcriptional activity by anti-acne reagents. J Dermatol Sci 2004;36:97-101. 2. Chew GY, Hawkins CA, Cherian M, Hurwitz M. Roxithromycin induced hypersensitivity pneumonitis. Pathology 2006;38:475-7. 3. Rahman Z, Weinberg J, Scheinfeld N. Minocycline hypersensitivity syndrome manifesting with rhabdomyolysis. Int J Dermatol 2002;41:530-1. 4. Compton MR, Crosby DL. Rhabdomyolysis associated with azathioprine hypersensitivity syndrome. Arch Dermatol 1996;132:1254-5. 5. Fontaine C, Guiard-Schmid JB, Slama L, Essid A, Lukiana T, Rondeau E, et al. Severe rhabdomyolysis during a hypersensitivity reaction to abacavir in a patient treated with ciprofibrate. AIDS 2005;19:1927-8.A case of herpes gestationis: Follow-up study of autoantibodies using enzyme-linked immunosorbent assay and immunoblotting Sir, Herpes gestationis (HG) is a rare autoimmune-mediated bullous disease that occurs during pregnancy and post partum, and may exacerbate after delivery. [1] IgG autoantibodies in HG bind to the 16 th noncollagenous domain (NC16a) of bullous pemphigoid antigen 180 (BP180), which is also recognized by bullous pemphigoid (BP). [2] We herein present a case of HG in which we examined the correlation among the results of enzymelinked immunosorbent assay (ELISA), immunoblotting and disease activity along the time course.A 27-year-old Japanese female in the 36 th week of her first pregnancy had a pruritic infiltrative erythema on the extremities. After delivery in the 38 th week of her pregnancy, she developed widespread infiltrative erythema with small tense vesicles on the extremities and back [ Figure 1a]. The patient also showed pruritic vesicles on the palms and soles, resembling dyshidrosis. The skin of her newborn baby was normal. A skin biopsy specimen taken from a lesion on the thigh revealed subepidermal blisters with perivascular eosinophilic and lymphocytic inflammatory infiltrate [ Figure 1b]. Direct immunofluorescence of the perilesional skin showed linear IgG and C3 deposits along the basement membrane zone (BMZ) [ Figure 1c]. Indirect and complement immunofluorescence using normal human skin as a substrate revealed circulating IgG anti-BMZ autoantibodies at a titer of 1:10. Indirect and complement immunofluorescence of the normal human skin split by 1 mol/L NaCl showed positive reaction (1:10) on the epidermal side of the split for IgG antibodies and C3 [ Figure 1d]. Immunoblotting using normal human epidermal extract revealed IgG antibodies to BP180 (data not shown). Immunoblotting using the recombinant protein of BP180 NC16a demonstrated that circulating IgG antibodies reacted with this protein. The BP180 ELISA index was positive (index: 79.42). These clinical and immunologic features lead us to the diagnosis of HG.Initial treatment with topical steroid for a week was not effective. At that time, antihistamine was not added because the patient refused to take it. Subsequently, a combination therapy with topical steroid and oral antihistamine (the patien...

Classification and Antigen Molecules of Autoimmune Bullous Diseases

“…Pemphigoid gestationis (herpes gestationis) is considered to be BP arising during pregnancy or the postpartum period. IgG autoantibodies against the NC16a domain of BP180 could be found in patient sera, and their titers are well correlated with disease activities along the disease course [ 40 ].…”

Treatment of Autoimmune Bullous Diseases During Pregnancy and Lactation: A Review Focusing on Pemphigus and Pemphigoid Gestationis

“…This is due to a systemic absorption, most encountered when used on the skin of eyelids, genitals and folds. Successful treatment with topical corticosteroids as monotherapy has also been reported in PG, particularly for mild or localized skin lesions during pregnancy but also after delivery, for mild relapses (e.g., during menses) (Cozzani et al, 2005;Fukuda et al, 2012;Ingen-Housz-Oro et al, 2016).…”