Perinatal Outcome of Pemphigoid Gestationis: A Report of Three Cases and Review of the Literature

Abstract

Pemphigoid gestationis (PG) is a rare autoimmune blistering disorder that typically manifests during the second or third trimester of pregnancy. It is characterized by intensely pruritic urticarial plaques and blister formation, driven by an autoimmune response against the BP180 protein in the basement membrane. In this report, three cases of PG are presented, each illustrating distinct clinical courses and management strategies. The first case involves a 32-year-old primigravida at 31 weeks of gestation who presented with abdominal blisters that were unresponsive to topical steroids. Oral prednisone at a dosage of 15 mg was initiated at 33 weeks, leading to the resolution of the rash by 37 weeks. She subsequently delivered vaginally at 40 weeks. The second case concerns a 37-year-old multigravida who developed blisters on her limbs and abdomen at 27 weeks, which improved with the application of topical steroids. Due to a history of a previous cesarean section, she delivered via elective cesarean section at 38 weeks. The third case involves a 35-year-old multigravida who experienced fetal growth restriction starting from 29 weeks. She developed a mild erythematous, pruritic rash, and blisters at 33 weeks and required an emergency cesarean section at 33 weeks due to non-reassuring fetal status. The diagnosis of PG was confirmed postpartum. These cases underscore the clinical variability and potential complications associated with PG. They also suggest that the severity of PG's cutaneous manifestations may not directly correlate with pregnancy outcomes. Early detection and individualized management are crucial to optimizing both maternal and neonatal outcomes.

Keywords: dermatoses of pregnancy; low birth weight; pemphigoid gestationis; preterm birth; skin lesions.

Figure 1. Clinical and Histopathological Findings in Case 1

(a) Clinical photograph of Case 1 showing erythema and blister formation around the umbilical area and extremities. (b) Hematoxylin and eosin (H&E)-stained section of the skin biopsy from Case 1, demonstrating subepidermal blistering with neutrophilic infiltration. Scale bar = 20 μm.

Figure 2. Clinical and Histopathological Observations in Case 2

(a) Clinical photograph of Case 2 illustrating extensive erythema and blistering around the umbilical region. (b) Hematoxylin and eosin (H&E)-stained section of the skin biopsy from Case 2, showing subepidermal blistering accompanied by neutrophilic infiltration. Scale bar = 20 μm.

Figure 3. Clinical, Histopathological, and Immunofluorescence Analysis in Case 3

(a, b) Clinical photographs of Case 3 showing scattered erythema and blistering on the palms and thighs. (c) Hematoxylin and eosin (H&E)-stained section of the skin biopsy from Case 3, demonstrating subepidermal blister formation with neutrophilic infiltration. Scale bar = 20 μm. (d) Immunofluorescence staining of the skin biopsy from Case 3, revealing IgG deposition in the subepidermal blister area. Scale bar = 20 μm.

Figure 4. Histopathological Examination of the Placenta in Case 3

Hematoxylin and eosin (H&E)-stained section of the placenta from Case 3, showing degenerated villi with extensive fibrin deposition in the intervillous spaces. Scale bar = 20 μm.

Figure 5. Immunofluorescence Findings in the Placenta from Case 3

Immunofluorescence staining of the placenta from Case 3, demonstrating IgG deposition around the blood vessels. Scale bar = 100 μm.