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Advanced Pemphigoid Gestationis Initially Misdiagnosed as Pruritic Urticarial Papules and Plaques of Pregnancy

Michael Roche, Odessa Hamidi, Grace Weyant, Jaimey Pauli

Background: Dermatoses of pregnancy are a common diagnostic challenge faced by obstetricians.

Case: A 34-year-old, gravida 5 para 1122, presented in the second trimester with a rash on bilateral lower extremities. She was diagnosed with pruritic urticarial papules and plaques of pregnancy (PUPPP) and given topical corticosteroids. Her symptoms worsened despite further treatment with oral corticosteroids. She was transferred to our hospital after presenting to her local emergency department. A presumed diagnosis of pemphigoid gestationis (PG) was made, and biopsies were taken. She was started on intravenous and topical corticosteroids with alleviation of her symptoms. Biopsies returned confirming PG.

Conclusion: PG is a rare condition whose presentation can mimic more common dermatoses of pregnancy. When symptoms do not improve despite adequate therapy, alternative diagnoses should be considered.