Pemphigoid gestationis associated with gestational trophoblastic neoplasia: A case report

Abstract

Pemphigoid gestationis (PG) is well described in pregnancy, classically presenting as a pruritic, periumbilical rash in multiparous women in the second or third trimester. We describe a unique case of a woman with gestational trophoblastic neoplasia (GTN) status post dilation and curettage on methotrexate (MTX) who presented with a diffuse, pruritic rash. After the rash persisted and flared despite multiple cycles of MTX, biopsies were obtained supporting a diagnosis of PG. It is important to consider PG on the differential in non-pregnant patients with GTN with a persistent pruritic rash, even in the setting of ongoing treatment with MTX.

Keywords: Gestational trophoblastic neoplasia; Methotrexate; Pemphigoid gestationis.

Fig. 1

Clinical timeline including treatments, course of rash, and eventual diagnosis of pemphigoid gestationis.

Fig. 2

Progression of abdominal rash from A) initial presentation to dermatology (annular pink scaly papules and plaques), B) after two weeks (pink edematous papules with slight vesiculation), and C) after two months (round patches with minimal erythema and post-inflammatory hyperpigmentation).

Fig. 3

Punch biopsy of abdominal lesion (Hematoxylin-Eosin stain, 20X magnification). Slight spongiosis, interface dermatitis, and a perivascular and interstitial lymphohistiocytic inflammatory cell infiltrate with numerous eosinophils. Eosinophils are seen in close proximity to the dermoepidermal junction.