[Neurologic manifestations in a child of a mother with gestational herpes]

[Pemphigoid gestationis and aplasia cutis congenita: report of a case]

La pemphigoïde gestationis est une dermatose gravidique apparaissant en général entre la 28^ème et la 32^ème semaine d'aménorrhée. L’éruption cutanée est prurigineuse, bulleuse ou vésiculopapuleuse et de topographie péri-ombilicale. Outre la clinique, son diagnostic repose sur la biopsie cutanée avec analyse en immunofluorescence directe. Elle se caractérise par sa tendance à récidiver. Le traitement habituel nécessite des dermocorticoïdes. Les conséquences peuvent être maternelles (menace d'accouchement prématuré), fœtales (retard de croissance intra-utérin), et néo-natales (éruption cutanée). Nous rapportons un cas de pemphigoïde gestationis associé à une aplasie cutanée congénitale type 2. S'agit il d'une association fortuite?

A case report of neonatal convulsions due to maternal herpes gestationis

Herpes gestationis is a rarely seen autoimmune vesiculobullous and pruritic dermatosis of pregnancy. Neonatal morbidity associated with maternal herpes gestationis is controversial. The authors report the first case of neonatal convulsion with abnormal electroencephalography findings and transient vesicular eruption due to maternal herpes gestationis.

[Pemphigoid gestationis: a study of 20 cases]

INTRODUCTION

Pemphigoid gestationis is a bullous autoimmune sub-epidermal dermatosis, occurring during pregnancy and/or postpartum. The objective of our study was to define the epidemio-clinical profile, the histopathological and immunopathological features, the treatment and the course of pemphigoid gestationis in Tunisian patients.

PATIENTS AND METHODS

This was a retrospective study concerning the cases of pemphigoid gestationis recorded between 1989 and 2003 in the dermatology department in La Rabta Hospital in Tunis. The patients were included according to clinical, histopathological and immunopathological criteria.

RESULTS

We retained 20 patients: 15 multiparae and 5 primiparae. The average age at onset was 29. The first clinical signs appeared in the 3rd trimester in 60 p. 100 of all cases. Clinically, the urticarial patches were noticed in 90 p. 100 of all cases and blisters in 65 p. 100 of the cases. The eruption was located mainly on the trunk and the limbs. The face was affected in 7 cases, the mucous membranes in 3 cases, the palms in 2 cases and the soles in 1 case. Cutaneous histologic examination revealed a sub-epidermal blister in 11 cases and a lymphohistiocyte infiltrate in all cases. Direct immunofluorescence showed a linear deposition of the third component of the complement along the basement membrane zone in all cases. Fetal prognosis was assessed in 13 cases: 1 fetal death, 1 still-born, 3 miscarriages, 1 anencephaly and 2 cases of transit bullous affection in the new-born.

DISCUSSION

Our results are similar to those in the literature, but with some particular aspects: the late onset of the pemphigoid gestationis in the course of the 3rd trimester of pregnancy, the frequent involvement of the face and the mucous membranes and the absence of the two main fetal risks: prematurity and hypotrophy. Moreover, we underline the efficiency of topical class I corticosteroids in the treatment of pemphigoid gestationis.

[Pemphigoid gestationis and vasculorenal syndrome: a fortuitous association?]

Pemphigoid gestationis is a gestational skin disease usually appearing between the 28th and the 32nd week of amenorrhea. It is a rare vesiculobullous skin disease and the eruption is located around the umbilicus. The diagnosis is made with clinical symptoms but mainly on histologic examination (after skin biopsy) and direct immunofluorescence. One of the main complications is the rate of recurrence. The main treatment is based on topical corticosteroids. The effects of the pemphigoid gestationis are maternal (preterm labor), fetal (intrauterine growth retardation) and neonatal (bullous disease). We report a case of pemphigoid gestationis associated to a gestational hypertensive disorder and we try to rely on both entities.

[Pemphigoid gestationis and bullous lesions in the newborn]

BACKGROUND

Pemphigoid gestations is very seldom responsible for cutaneous lesions in newborns through passive transfer of the autoimmune disease from mother to infant.

CASE REPORT

We report an additional case of a newborn presenting with an extensive but transitory bullous eruption despite the absence of circulating autoantibodies.

CONCLUSION

Such examples of transplacental pemphigoid are so uncommon that the pathogenic role of IgG autoantibodies is being questioned.