Atypical polymorphic eruption in pregnancy confirmed with a negative C4d immunohistochemistry: a case report
Abstract
Polymorphic eruption in pregnancy (PEP)is one of the most common dermatoses in pregnancy but is currently an underreported condition. It is important to distinguish this from pemphigoid gestationis (PG) due to their difference in pathophysiology and prognosis. This is a case of a 40-year-old female with a more than one year history of pruritic, tense vesicles and erythematous urticarial plaques on the face, gradually spreading to the chest, abdomen, and bilateral upper and lower extremities, with no other associated signs and symptoms. Lesions initially started in the first trimester of pregnancy, had transient resolution upon delivery, and had recurrence in the post-partum period. Skin biopsy findings were suggestive of pemphigoid gestationis. Further workups however were consistent with polymorphic eruption in pregnancy with the direct immunofluorescence and C4d immunohistochemistry yielding negative results. Patient was started on high potency topical corticosteroids and oral antihistamines which brought about significant improvement. When presented with multiple vesicles in a pregnant woman and during the post-partum period, an initial diagnosis of pemphigoid gestationis is commonly made. However, an atypical presentation of polymorphic eruption in pregnancy must be considered as a close differential, hence it is important to perform the necessary laboratory workups which include histopathology, direct immunofluorescence, and immunohistochemistry studies. To distinguish PG from PEP is necessary for proper patient appraisal regarding the course and prognosis of her condition.
Copyright (c) 2023 Andrea Isabel Contreras, Ma. Pacita Belisario
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