Nasser Rashid Dar, Shahida Akhtar, Mumtaz Ahmed, Imran Roshan.
Neonatal Pemphigus in a baby boy born to a mother with Pemphigus Vegetans - A case report.
J Pak Assoc Derma Jan ;10(1):35-7.

A twenty years old primigravida female presented with two months history of blister formation and erosions over her body and in her oral mucosa. She was pregnant for the last eight months. Examination reveled extensive flaccid blisters over her trunk, limbs, face and in her mouth. The blisters were filled with straw colored fluid. At places raw erosions were seen where the blisters have ruptured. In axillae vegetating lesions were present. Oral mucosa showed extensive erosions covering almost all portions of oral cavity. Obstetrical examination revealed a fundal height of 33 weeks and normal heart sounds. Examination of the external genitalia showed florid vaginal candidiasis. Systemic examination was unremarkable. Tzank smear from base of a blister showed the presence of acantholytic cells. Biopsy from an intact blister revealed by perkeratosis, and intra epidermal blister with acantholytic cells. There was a mixed inflammatory cell infiltrate containing eosinophil in the epidermis and dermis. Direct immunofluorescence studies on skin biopsy should deposition of IgG in the intercellular spaces throughout its thickness. Ultrasound of the abdomen confirmed the gestational age and revealed a cephalic lie of the fetus No other fetal abnormality was detected. Her blood chemistry was within normal limits and x-ray chest revealed no abnormality. Based on these findings she was diag nosed as having pemphigus vegetans and was started on 120 mg of prednisolone per day. No immunosuppressive was added because of her pregnancy. Poor response was noted after three weeks of treatment and the dose of prednisolone was increased to 170 mg per day. On 38 weeks of gestation she developed labor pains and delivered a baby boy weighing 3000 gm by normal vagina] delivery. Examination of the baby revealed flaccid blisters and erosions over trunk and limbs especially over areas of friction. No oral lesion was seen. Tzank smear from the base of a blister revealed acantholytic cells. Biopsy could not be performed as it was not permitted by the parents. Indirect immunofluorescence studies were not performed. The baby was otherwise afebrile, healthy and active. The baby remained afebrile and took mother feed well. The mother feed was only restricted for two and a half hours af ter taking of daily close of prednisolone. The baby thrived well and his skin lesions healed completely in three weeks time without any specific treatment. The mother showed improvement with healing of the lesions and the close of prednisolone was tapered off. At present both the mother and the child are healthy with the mother controlled on 30mg of prednisolone daily.

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