Pemphigus vulgaris complicated by pregnancy
THOMAS W. McELIN, M.D. M.S.
DAVID W. CROMER, M.D.
Ez•anston. Illinois
p E M P H I G U S V U L G A R I S lS a chronic
bullous skin disease which, if untreated, is
usually fatal.l It is an uncommon dermato-
logic entity, and the association with preg-
nancy is quite rare. In 1953, Samitz, Green-
berg, and Coletti~ presented a case of pem-
phigus complicated by pregnancy and re-
viewed 10 previously published cases. In each
prior report, pemphigus appeared after the
onset of pregnancy: however, in the case of
Samitz, Greenberg, and Coletti~ the skin
lesions were present 3 months prior to the
onset of pregnancy. No additional case re-
ports have been discovered in the English
literature, and only two articles from foreign
journals (Belgium, 1960, Italy, 1962) were
listed in the !rl(ic.\' Afcdicus.
We report a patient who had pemphigus
vulgaris and then became pregnant,
Case report
A gravida iii, para i, Negro woman began her
third pregnancy in May, 1959, at a,gc 38. Her
estimated date of confinement was the middle of
February, 1960. At the orm•t of gestation she was
taking a corticosteroid (triamcinolone, 12 mg.
daily) and corticotropin ( ACTH, 20 units) twice
a W('ek for pemphigus vulgaris.
Pemphigus was diagnosed in October, 1956,
3 wPeks after the onset of bullae and vesiclrs on
the buccal mucosa, shoulders, and arms. The
weeping lesions spr('ad over almost the entirr in-
tegunwnt including thr scalp, nostrils, and extr·r-
nal genitals. Shr was hospitalized at that tim<' lw-
rausc of srcondary bactt•rial inf('ctinn and was
From the Department of Obstetrics and
Gvnecology. Northwestern University
Medical School, Chicago, Illinois, and
the Department of Obstetrics and
Gynecology, The Evanston Hospital.
1122
placed on steroids and AC:TH with a good n·-
sponsc. The disease was w!'!l controlled until
August, 1957, when an exacerbation followed the
reduction of steroid thrrapy. Hospitalization fot
one month with increased steroids (prednison•·,
40 mg. daily) and ACTH (+0 units wr•t•kly) !'1'-
sultcd in marked irnprowrnrnt. "\ second major
remission followed with the patient 011 continuous
steroid and intermittf•nt ACTH thnapy which
was adjusted as indicated during biwet·kly visit'
tu the outpatient clinir.
Th,· pati<'nt's past medical history was unre-
\·caling <'xcept for the diagnosis and tr<'atmcnt of
syphilis in 1ClJ<J. \Vithout recutT<'ll<"<' or residual
•·ffccts.
The past ob.st<'tri•·al historY includ•·d ;nt ttn-
,.,.,.tltfnl tl'rlll pregnancy with tlw d<'livr·n nf "
viabk infant in 1945, and a spontaneous a!J<Jrtion
at 3 months n·quiring a dilatation and r·urTttag•·
in 195-L
The patir•nt 's skin condition l!'nt;rirwd s;ttisfa,·-
tory during tlw prcs<'nt prq:;nann·. ··xc•·pt for
patcht·s of hypt'rpignwntation and liclwnificatinn,
until tilt' fifth month. A r<'ctnT<'nt'<' nf '' ··r·pintl,
infectr·d !•·~<ions, mainly in 1h·· axilla<' and utt 1h··
tnmk. rl<'l'cssitated hospitalization on (kt. ~1.
I t).'j~) (Fig. l ! . This was her most ,,., <'n· qlisod•·
sinn· the onset of tn'atnt<'nt. ACTIT had been
discontinucd :.! months prior lo admission, hut it
was no,,· reinstituted without rnuch n·spom•'. I tll-
prnv<'!IH'nt began only aft<'r tiH' form of stnoid
was changed (prcdnisont', ~(I mg. daily. \\as 'ttb-
stitutcd for triamcinolnnc). On l\'ov<'nther I !'i.
whilt' the patient was still in tfw hospital. Lt!so•
labor ensur•d and suhsidl'd aft<'r :.! days of int .. r-
lllitknt uterine contraction.s. Slw 1\"<1!-. discharged
J),•n·mh<'r R. in n·mission, and <'XJWricnt cd no
further nttanenus rnmplicatiom durin.[( thf' prr·g-
nancy.
Exc('pt for the brief cpisodt· of contractions,
the prPgnancy itself was uneventful until the pa-
tient entered the labor room Jan. 2+, Elf)()_ one