Blisters and Erosions in a Neonate

Abstract

A newborn male infant was transferred to the neonatal intensive care unit for widespread vesicles and erosions evident at birth, following a spontaneous vaginal delivery complicated by fetal meconium exposure. The mother, initially unavailable for examination because she remained at the facility where she had given birth, reported via telephone that she was healthy except for a urinary tract infection for which she had taken a 7-day course of nitrofurantoin monohydrate approximately 3 to 4 weeks before delivery. She denied a history of herpesvirus infection, blistering disorder, or autoimmune disease. On physical examination, the neonate exhibited extensive erosions rimmed by purulent vesicles involving the groin, neck, scalp, fingers, and left side of the upper chest ( Figure, A and B). Mucous membranes were spared. Biopsy specimens were obtained, with results as shown in the Figure,

Autoimmune Pemphigus: Latest Advances and Emerging Therapies

“…Neonatal pemphigus vulgaris (NPV) is a transient immunobullous disease induced by transplacental transfer of maternal autoantibodies from a mother with PV to her newborn (Fenniche et al, 2006;Gushi et al, 2008;Turrentine et al, 2014;Carvalho et al, 2019;Fenner et al, 2020;Foster et al, 2021). First reported in 1975(Salihbegović-Opalić et al, 1975Zhao et al, 2016), few cases exist in the literature, as female patients with pemphigus can experience infertility, premature delivery and stillbirth (Ouahes et al, 1997).…”

Neonatal Pemphigus Vulgaris

“…Neonatal pemphigus vulgaris is a transient blistering disorder caused by passive transfer of maternal IgG autoantibodies across the placenta during pregnancy . The risk of an infant developing neonatal pemphigus exists independently of levels of maternal antibody titers and/or mucocutaneous presentation at time of gestation . The distribution of ulcerative lesions in the neonate failed to reflect the pattern visible in the mother .…”

“…The risk of an infant developing neonatal pemphigus exists independently of levels of maternal antibody titers and/or mucocutaneous presentation at time of gestation . The distribution of ulcerative lesions in the neonate failed to reflect the pattern visible in the mother . Widespread disease in the neonate was a result of desmoglein-3 expression in the neonatal mucosal and cutaneous surfaces.…”

“…Often, undetectable levels of antibody titers are seen in the infant shortly postdelivery; resolution of symptoms can be seen by age 3 weeks . Therapy aims to support reepithelization of the skin and mucous membranes and prevent concomitant infection . Treatment comprises emollients, topical corticosteroids, and anitbiotics .…”

“…Therapy aims to support reepithelization of the skin and mucous membranes and prevent concomitant infection . Treatment comprises emollients, topical corticosteroids, and anitbiotics . Follow-up with monitoring of symptoms and levels of antibodies is recommended until age 1 year .…”