Pregnancy with Pemphigoid Gestationis: A Rare Entity

Abstract

A 24-year-old unbooked G 2 P 1 L 0 (2 nd gravida, para 1 but no living issue) presented at 6 months amenorrhea with increased Blood Pressure (BP) records. She was diagnosed Pemphigoid Gestationis (PG) in her first pregnancy after confirmation on skin biopsy and direct immunofluorescence (DIF) [Table/ Fig-1]. There were no postpartum flare-ups though she continued irregular and self medication of prednisolone. On examination, there were fresh bullous lesions along with old healed scar marks on the abdomen and limbs [Table/ Fig-2,3]. Uterus corresponded to 24-26 weeks of gestation with a single live fetus. She was started on antihypertensive drugs and dermatology review was done. Prednisolone (15 mg OD) was started. Strict maternofetal surveillance was done. Her haemogram, RFT, liver function tests, fundus and ultrasound for kidneys were normal. Due to uncontrolled BP, decision for termination was taken. Patient delivered a still birth weighing 750 gm. No postpartum flare ups of PG were noted. She was discharged on prednisolone in a satisfactory condition. DisCussionPemphigoid Gestationis (PG) also known as herpes gestationis is a rare autoimmune blistering disease with an incidence of 1/50000 pregnancies [1]. Presentation in the second or third trimester is most common and tends to recur in subsequent pregnancies Keywords: Autoimmune Pemphigoid Gestationis (PG) is a rare autoimmune blistering disease with an incidence of 1/50000 pregnancies. Presentation in the second or third trimester is most common and tends to recur in subsequent pregnancies with earlier onset and a more severe course. Direct Immunofluorescence (DIF) staining is confirmatory on skin biopsy specimen. A 24-year-old female presented at 6 months period of gestation with increased blood pressure records. On examination, there were fresh bullous lesions along with old healed scar marks on the abdomen and limbs. Termination of pregnancy was done due to high BP. Patient delivered a fresh still birth weighing 750 gm. No postpartum flare ups were seen and she was discharged on prednisolone in a satisfactory condition.

Benefits and Risks of IgG Transplacental Transfer

“…This is an AIBD caused by the production of autoantibodies against adhesion molecules, mainly against bullous pemphigoid BP180 or collagen XVII [ 104 ]. Clinically the condition is described as itchy, red skin with blisters mainly in the umbilical zone, but also in other areas of the body ( Figure 6 ) appearing in the second and third trimesters [ 105 , 106 ].…”

Direct immunofluorescence microscopy findings of autoimmune vesiculobullous dermatitis

“…Bu morfolojik tablo "Gebeliğin kaşıntılı ürtikaryal papül ve plakları" ile büyük benzerlik gösterir ve sadece ışık mikroskobik olarak ayrım yapılamaz. Ayrımda DİF inceleme oldukça önemli ve tanı koydurucudur (51,52).…”

Bullous Pemphigoid

“…The disease can be seen in any trimester of the pregnancy as well as postpartum [26]. The incidence ranges from 1/50.000 to 1/1700 [24,27]. The triggering factors are not known [27].…”

“…The incidence ranges from 1/50.000 to 1/1700 [24,27]. The triggering factors are not known [27]. Graves' disease is the most commonly detected secondary autoimmune disease [24].…”