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SHORT COMMUNICATION
Year : 1994  |  Volume : 60  |  Issue : 2  |  Page : 82-84

Pemphigus vulgaris and pregnancy




Correspondence Address:
Kalyan Banerjee


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  Abstract 

Permphigus vulgaris during pregnancy is extremely rare; 2 such immunopathologically confirmed cases were treated by us. Case 1 delivered normal child; in case 2 a macerated foetus was born with extensive features of Neonatal pemphigus vulgaris survived for 10 days.


Keywords: Pemphigus vulgaris with pregnancy, Transplacental transmission, Neonatal pemphigus vulgaris


How to cite this article:
Banerjee K, Banerjee R. Pemphigus vulgaris and pregnancy. Indian J Dermatol Venereol Leprol 1994;60:82-4

How to cite this URL:
Banerjee K, Banerjee R. Pemphigus vulgaris and pregnancy. Indian J Dermatol Venereol Leprol [serial online] 1994 [cited 2019 Sep 19];60:82-4. Available from: http://www.ijdvl.com/text.asp?1994/60/2/82/3999



  Introduction Top


Pemphigus vulgaris with pregnancy is extremely rare condition, due to improvement of recent immunopathological testing so far 16 cases have been published. [1],[2] Foetal mortality is high due to transplacental transmission of pemphigus antibody from mother to child. [3],[4] Risk of using teratogenic immuno suppressive drug may produce defect in the foetus.

Case I. A 35-year-old women, para 6 was reported with flaccid bullae all over the body specially on abdomen, thighs & back with a duration of 2 months. Blood bio chemistry was normal. High WBC count 26,000 cmm. with raised ESR 160 mm was the only positive findings. Bacteriogical culture was positive for staphylococcus aureus. In histopathology typical suprabasal bullae with acantholysis was seen. [Figure - 1] Material send for direct immunoflorescence was positive; IgG level I : 540. Patient was treated with systemic steroid (120 mgm per day), azathioprine (150 mgm per day), weekly dosage of cyclophosphamide (200 mgm). Pregcolor test was positive. Patient delivered normal baby, his chord blood was examined for pemphigus antibody found negative.

Case II. A 40-years-old women para 8 reported with history of P. vulgaris in late pregnancy about 8 months duration. Vaginal and oral mucous membranes were extensively involved with erosions & ulcers. No sign of toximea seen. Direct immunopathological testing showed florescence at the intracellular bridges [Figure - 2] IgG level 1 : 640, with high WBC count 30,000 cmm with raised ESR 208 mm. Virological culture negative for cytomegalovirus. Bacteriological culture was positive for staphylococcus aureus. Treated with systemic steroid and immunosuppressive agents like previous case. Supportive therapy, blood transfusion, antibiotic cefatoxime was also given. At full term she delivered a maccerated foetus which we apprehended from ultrasonographic foetal monitoring [Figure - 3]. Material send for direct immuno histopathological testing it was positive. IgG level chord blood was positive 1 : 6. The baby died after 10 days.


  Comments Top


Role of circulating autoantibodies (mainly IgG) in the pathogenesis of P. vulgaris have long been debated. [5],[6] Presence of circulating immunoglobuline is the cause of disease or secondary to some primary stimulus is difficult to ascertain. Autoantibody thus produced directed against attachment function between epidermal cells have been established. Passive transfer of P. vulgaris patient's serum to animals [7],[8] and cultured human keratinocytes [9] & simultaneous development of acantholysis [10] attributed to role of immunoglobuline in the disease process. Co-relation of disease activity along with P. vulgaris antibody titre and amelioration of disease by plasma pheresis speak for role of IgG in such cases." In our cases we were forced to use immuno­suppressive agents because they didn't improve with simply systemic steroid and other supportive therapy.

IgG class antibody is capable to cross placental barrier to produce neonatal P. vulgaris or macerated foetus. Use of immunosuppresive agents may produce birth defect.[11]

 
  References Top

1.David Green, et al. Maternal pemphigus vulgaris with in vivo bound antibodies in the stillborn foetus. J Am Acad Dermatol 1992; 27: 388.  Back to cited text no. 1    
2.Goldberg, et al. Pemphigus Vulgaris and pregnancy : Risk factors and recommendations. J Am Acad Dermatol 1993; 28 : 877.  Back to cited text no. 2    
3.Moncada B, Kettelsen S, Hernandez­Moctezumal JL, et al. Neonatal pemphigus vulgaris : role of passively transferred pemphigus antibodies. Br J Dermatol 1982; 106 : 465-8.  Back to cited text no. 3    
4.Wasserstrum N, Laros RK. Transplacental transmission of pemphigus. JAMA 1983; 249 1480-2.  Back to cited text no. 4    
5.Okano M, Takijiri C, Aoki T, et al. Pemphigus vulgaris associated with pregnancy : a case report from Japan. Acta Derm Venereol (Stockh) 1990; 70 : 517-9.  Back to cited text no. 5  [PUBMED]  
6.Terpstra H, de Jong MCJM, Klokke AH, et al. In vivo bound pemphigus antibodies in a stillborn infant. Arch Dermatol 1979; 115 : 316-9.  Back to cited text no. 6    
7.Chorzelski TP, Beutner EH, Jarzabek, M. Passive transfer of pemphigus in experimental animals. Int Arch Allergy App Immunol 1970; 39: 106.  Back to cited text no. 7    
8.Holubar K, Chorzelski TP, Gauto M, et al. Studies in immunodermatology. III. Induction of intraepithelial lesions in monkeys by intramucosal injections of pemphigus antibodies. Int Arch Allergy Appl Immunol 1973; 44 : 631-43.  Back to cited text no. 8  [PUBMED]  
9.Michel B, Ko CS. An organ culture model for the study of pemphigus acantholysis. Br J Dermatol 1977; 96: 295-302.  Back to cited text no. 9  [PUBMED]  
10.Schiltz JR, Michel B. Production of epidermal acantholysis in normal human skin in vitro by the IgG fraction from pemphigus serum. J Invest Dermatol 1976; 67 : 254-60.  Back to cited text no. 10  [PUBMED]  
11.Fitzpatrick R, Newcomer V. The correlation of disease activity and antibody titers in pemphigus. Arch Dermatol 1980; 116 - 285-90.  Back to cited text no. 11    


    Figures

[Figure - 1], [Figure - 2], [Figure - 3]



 

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