A case of chronic herpes gestationis: Persistent disease or conversion to bullous pemphigoid?

We report the case of a 38-year-old woman with herpes gestationis (HG) persistent for 26 months postpartum with typical erythematous-edematous grouped lesions associated with vesicles, blisters, and scaled crusts on most parts of her body. Despite high doses of oral prednisolone, azathioprine, and d...

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Bibliographic Details
Published in:Journal of the American Academy of Dermatology 2003-08, Vol.49 (2), p.302-307
Main Authors: Amato, Lauretta, Mei, Sandra, Gallerani, Isabella, Moretti, Silvia, Fabbri, Paolo
Format: Article
Language:English
Subjects:
Adult
Biological and medical sciences
Bullous diseases of the skin
Chronic Disease
Dermatology
Diagnosis, Differential
Disease Progression
Female
Fluorescent Antibody Technique
Glucocorticoids - therapeutic use
Humans
Medical sciences
Pemphigoid Gestationis - complications
Pemphigoid Gestationis - diagnosis
Pemphigoid Gestationis - drug therapy
Pemphigoid, Bullous - complications
Pemphigoid, Bullous - diagnosis
Pemphigoid, Bullous - drug therapy
Plasmapheresis
Prednisone - therapeutic use
Pregnancy
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Summary:We report the case of a 38-year-old woman with herpes gestationis (HG) persistent for 26 months postpartum with typical erythematous-edematous grouped lesions associated with vesicles, blisters, and scaled crusts on most parts of her body. Despite high doses of oral prednisolone, azathioprine, and dapsone, and a trial of 5 plasmaphereses, the disease has persisted to date. Histopathologic examination of lesional skin showed subepidermal blisters, focal basal cell necrosis, and a dermal inflammatory infiltrate including many eosinophils. Direct immunofluorescence showed linear C3 staining in the basement membrane zone and the complement fixation test demonstrated circulating antibasement membrane zone antibodies at a low titer (1:80). HLA typing demonstrated an A2, A24, B35, B52, DR4,5, DR13,15, DRW52,53 phenotype. We present this case as chronic persistent HG and discuss the differential diagnosis between chronic persistent HG and HG evolving to bullous pemphigoid, together with a careful examination of similar cases reported in literature.
ISSN:0190-9622
1097-6787
DOI:10.1067/S0190-9622(03)00412-2