DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20174469

Pemphigus vulgaris in pregnancy with transient neonatal pemphigus - can psychological stress be culprit?

Nisha Bhagat, Rajnish Raj, Ritu Arora

Abstract


Pemphigus vulgaris (PV) is a rare life threatening, autoimmune bullous disease affecting mucous membrane and skin. Pregnancy and emotional stress may be the possible triggering factors for PV. It is a very rare phenomenon with less than 27 cases of pregnancy induced PV and only 9 cases of neonatal pemphigus reported in literature. The lesions may appear transient in neonate which resolve spontaneously over 2-3 weeks. We hereby, report a case of 26-year-old female who developed PV in second trimester of pregnancy with peripartum depression, which was managed by intravenous, oral and topical steroids and selective-serotonin reuptake inhibitor (SSRI). Furthermore, the development of transient neonatal pemphigus raises the possibility of genetic linkage from maternal to fetal transmission.


Keywords


Corticosteroids, Pemphigus vulgaris, Peripartum depression

Full Text:

PDF

References


Amagai M, Pemphigus. In: Dermatology (Bolognia J L, Jorizzo J, Rapini R P eds). London: Mosby. 2003: 449-62.

Joly P, Litrowski N. Pemphigus group (vulgaris, vegetans, foliaceus, herpetiformis, brasiliensis). Clin Dermatol. 2011;29:432-6.

Nandini G, Umadevi K, Padma K, Rajini Uday, Sahana R. Pemphigus Vulgaris with pregnancy. J South Asian Fed Obstet Gynaecol. 2012;4(3);159-60.

Langan SM, Smeeth L, Hubbard R, Fleming KM, Smith CJ, West J. Bullous pemphigoid and Pemphigus vulgaris. Incidence and mortality in the UK: population based cohort study. BMJ. 2008;337:180.

Firooz A, Mazhar A and Ahmed AR. Prevalence of autoimmune diseases in the family members of patients with Pemphigus vulgaris. J Am Acad Dermatol. 1994;31:434-7.

Cremniter D, Baudin M, Roujeau JC. Stressful life events as potential triggers of pemphigus. Arch Dermatol. 1998;134:1486-7.

Bialynicki-Birula R, Dmochowski M, Maj J, Gornowicz-Porowska J. Pregnancy-triggered maternal pemphigus vulgaris with persistent gingival lesions. Acta Dermatovenerol Croat. 2011;19:170-5.

Daneshpazhooh M, Chams-Davatchi C, Valikhani M, Aghabagheri A, Mortazavizadeh SM, Barzegari M et al. Pemphigus and pregnancy: a 23-year experience. Indian J Dermatol Venereol Leprol. 2011;77:534.

Lin L, Zeng X, Chen Q. Pemphigus and pregnancy: Analysis and summary of case reports over 49 years. Saudi Med Journal. 2015;36(9):1033-8.

American Psychiatric Association. Diagnostic and Statistical manual of mental disorders, 5th ed., Washington DC: American Psychiatric Association. 2013.

Bjelland I, Dahl AA, Haugg TT, Neckelmann D. The validity of the hospital Anxiety and Depression Scale: an update literature review. J Psychosom Res. 2002;52:69-77.

Beneke M and Rasmus W. Clinical global impressions (ECDEU): some critical comments. Pharmacopsychiatrie.1992;25:171-6.

Spielberger CD, Gorsuch RL, Lushene PR, Vagg PR and Jacobs GA. Manual for State-Trait Anxiety Inventory: Bibliography (2nd ed) Palo Alto, CA: Consulting Psychologists Press;1983.

Ruocco V, Ruocco E, Schiavo AL, Brunetti G, Guerrera LP, Wolf R. Pemphigus: Etiology, pathogenesis, and inducing or triggering factors: Facts and controversies. Clin Dermatol. 2013;31(4): 374-8.

Ruocco V, de Angelis E, Lombardi ML. Drug-induced pemphigus. II. Pathomechanisms and experimental investigations. Clin Dermatol. 1993; 11:507-13.

Caldarola G, Kneisel A, Hertl M, Feliciani C. Herpes simplex virus infection in pemphigus vulgaris: clinical and immunological considerations. Eur J Dermatol. 2008;18:440-3.

Ruocco V, Ruocco E. Pemphigus and environmental factors. G Ital Dermatol Venereol. 2003;138:299-309.

Ruocco V, Brenner S, Ruocco E. Pemphigus and diet: does a link exist? Int J Dermatol. 2001;40:161-3.

Morell-Dubois S, Carpentier O, Cottencin O. Stressful life events and pemphigus. Dermatology. 2008;216:104-8.

Muhammad JK, Lewis MA, Crean SJ. Oral pemphigus vulgaris occurring during pregnancy. J Oral Pathol Med. 2002;31:121-4.

Schmutz JL. Dermatological diseases influenced by pregnancy. Presse Med. 2003;32:1809-12.

Kalayciyan A, Engin B, Serdaroglu S, Mat C, Aydemir EH, Kotogyan A. A retrospective analysis of patients with pemphigus vulgaris associated with pregnancy. Br J Dermatol. 2002;147:396-7.

Matias AB and Roselino AMF. Pemphigus and psychological stress: a review of the literature. Our Dermatol Online. 2013;4(S3):616-8.

Mimouni D, Nousari CH, Cummins DL, Kouba DJ, David M, Anhalt GJ. Differences and similarities among expert opinions on the diagnosis and treatment of Pemphigus vulgaris. J Am Acad Dermatol. 2003;49:1059-62.

Kanwar AJ, Thami GP. Pemphigus vulgaris and pregnancy-a reappraisal. Aust N Z J Obstet Gynaecol. 1999;39:372-3.

Gurcan HM, Jeph S, Ahmed AR. Intravenous immunoglobulin therapy in autoimmune mucocutaneous blistering diseases: a review of the evidence for its efficacy and safety. Am J Clin Dermatol. 2010;11:315-26.

Shieh S, Fang YV, Becker JL, Holm A, Beutner EH, Helm TN. Pemphigus, pregnancy and plasmapheresis. Cutis. 2004;73:327-9.

Goldberg NS, DeFeo C, Kirshenbaum N. Pemphigus vulgaris and pregnancy: risk factors and recommendations. J Am Acad Dermatol. 1993;28(5.2):877-9.

Fainaru O, Mashiach R, Kupferminc M, Shenhav M, Pauzner D, Lessing JB. Pemphigus vulgaris in pregnancy: a case report and review of literature. Hum Reprod. 2000;15:1195-7.