Clinical experience in a pregnant woman with pemphigoid vulgaris
Keywords:
Pempphigus Vulgar, Gestation, Autoimmune Disease, Skin LesionAbstract
Introduction: pemphigoid vulgaris is a rare, severe, autoimmune disease with mucocutaneous involvement that has an aggressive course and chronic evolution. The origin depends on the interaction between predisposing genetic and environmental factors, which induce an immune response of the host against epidermal desmosomes.
Case report: 31-year-old pregnant woman at 31,2 weeks, who presented vesiculo-ampullary lesions at the periumbilical level at the beginning, and later extending all over the thorax, face along with upper and lower limbs, without mucosal involvement. A range of complementary tests were performed and a diagnosis of pemphigoid gestationalis vulgaris was made; treatment was started with prednisone, diphenhydramine, ciprofloxacin and clobetasol cream on the lesions, treatment was maintained until delivery, however, a new outbreak appeared, so azathioprine was added for 45 days with progressive decrease of prednisone, showing clinical improvement.
Conclusions: the diagnosis of pemphigus vulgaris requires a high index of suspicion to avoid delay in treatment and improve prognosis. Given the similarity with other more prevalent exanthematous diseases, it is necessary when there are diagnostic doubts in cases of unexpected evolution, to reevaluate the clinical manifestations together with the specialist and perform skin biopsy in the lesions and peri-lesions with histological study and direct immunofluorescence to confirm diagnosis.
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