The images above show vesicular, papular, and pruritic rashes across the abdomen, thorax, arms, and legs of a 30-year-old pregnant patient in her 34th week of gestation. She complains of the eruption of rash 5 days before presenting to the emergency department.
On physical examination, confluent papules with blisters on
the arms (Panel A), thorax, and abdomen (Panel B) were noted. The rest of the
examination was normal. Head, neck, and mucus membranes were spared. No lymph
nodes were palpable.
Serological tests were conducted to check the antibody levels.
The anti-bullous pemphigoid 180 antibody level was greater than 200 U/mL
(normal range: 0-20). The rest of the antibody titers were normal, including
antinuclear antibodies, anti-bullous pemphigoid 230 antibodies, anti-desmoglein
1 antibodies, and anti-desmoglein 3 antibodies.
A specimen
was obtained from the affected skin for histopathological analysis, which
showed modest interpapillary spongiosis extending into the skin adnexa. A mild
leucocytic infiltrate was seen around the superficial vessels along with a few
eosinophils. Immunofluorescence tests revealed IgM, IgG, and C3 on the subdermal
basal membrane.
What is the diagnosis?
This pregnant woman was diagnosed with pemphigoid
gestationis.
Systemic glucocorticoids were started, which resolved the
rash in 3 months. At 38-week-gestation, she gave birth to a healthy baby via
spontaneous vaginal delivery without any rash or associated complaints.
Pemphigoid gestationis
Pemphigoid gestationis was previously known as herpes
gestationis as the lesions resemble the herpetic lesions, so initially, herpes
was considered to be the culprit pathogen, which was later proven to be false.
This skin condition showed resemblance to the pemphigoid group of autoimmune
blistering skin disorders, hence the name.
Pemphigoid gestationis is when the body’s immune system malfunctions
and attacks its own cells; in medical jargon, it is classified as an autoimmune
disease. Patients with this rare skin condition usually present late in
the pregnancy, in the second or third trimester, with complaints
of severe itching and blisters. Sometimes, the only complaint may be itching as
it occurs even before the lesions erupt.
Are there any risks to the fetus?
The fetus is at risk of pre-term birth, and there is also a risk of small for gestational age (SGA). Low-birth-weight is another risk, especially if the disease onset is in the first and the second trimester of pregnancy.
Does the treatment with glucocorticoids adversely affect the developing fetus?
The use of glucocorticoids has not been seen to affect the obstetrical outcomes adversely. The fetus doesn’t show any side effects, either.
What is the risk of pemphigoid gestationis in subsequent pregnancies? لعبة اون لاين
Studies have shown that pregnant patients suffering from pemphigoid gestationis are at greater risk in the subsequent pregnancies with an earlier and more severe course. لعبة بوكر حقيقية
References
Paolo Agostinis, M. a. (2020, August 27). Pemphigoid Gestationis. Retrieved from The New England Journal of Medicine: https://www. العاب لربح المال الحقيقي nejm.org/doi/full/10.1056/NEJMicm2000922
Chi CC, Wang SH, Charles-Holmes R, et al. Pemphigoid gestationis: early-onset and blister formation are associated with adverse pregnancy outcomes. Br J Dermatol. 2009;160(6):1222-1228. doi:10.1111/j.1365-2133.2009.09086.x
Sävervall C, Sand FL, Thomsen SF. Pemphigoid gestationis: current perspectives. Clin Cosmet Investig Dermatol. 2017;10:441-449. Published 2017 Nov 8. doi:10.2147/CCID.S128144
