|May 2007 · Vol. 19, No. 05
Case: Blisters after deliveries (but only with husband no. 2)
Stillbirth is followed by skin changes that implicate the patient’s spouse. What’s going on?
When there are no blisters, it is impossible to distinguish pemphigoid gestationis from other cutaneous eruptions of pregnancy
Biopsy and immunofluorescence help differentiate pemphigoid gestationis from other dermatoses of pregnancy
University of Texas Health, Science Center at San Antonio
A 33-year-old Hispanic woman who was 5 months pregnant came to the hospital complaining of nausea and vomiting. She had a history of anticardiolipin antibody syndrome, diagnosed originally in 1993 after 2 spontaneous abortions. She had stopped taking warfarin (Coumadin) at the start of her pregnancy, and had been taking heparin for 3 months.
After 4 days of close monitoring, the patient had labor induced for severe life-threatening preeclampsia. One day after induction and delivery of a still-born fetus, she began to develop painful swelling of both hands and feet along with targetoid, urticarial, edematous, deep pink, slightly dusky papules and plaques on her hands, abdomen, lower extremities, and proximal thighs. Some of the edematous sites began to form vesicles and bullae (FIGURES 1 AND 2). When asked about this eruption, the patient mentioned having a similar rash after delivery of one of her children about 10 years before.