TITLE:
Severe Dermatological Blistering Diseases with Maternal-Fetal Risk: Two Case Reports during Pregnancy
AUTHORS:
Astou Coly Niassy, Ibrahim Rahadat, Babacar Biaye, Paglan Emilienne Peronne, Ndeye Racky Sall, Mame Diarra Ndiaye, Marie-Edouard Faye
KEYWORDS:
Pregnancy, Blistering Dermatoses, Toxic Epidermal Necrolysis, Pemphigus Vulgaris, Neonatal Pemphigus, Maternal-Fetal Prognosis
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.15 No.9,
September
12,
2025
ABSTRACT: Objective: To report two cases of severe blistering dermatoses during pregnancy—a toxic epidermal necrolysis (TEN) induced by sulfadoxine-pyrimethamine and a relapsing pemphigus vulgaris (PV) complicated by transient neonatal pemphigus, and to review the literature highlighting diagnostic, therapeutic, and prognostic considerations. Case reports: The first case involved a 27-year-old primigravida at 28 weeks’ gestation who developed TEN after intermittent preventive treatment of malaria with sulfadoxine-pyrimethamine. On admission, her SCORTEN score was 4/7, corresponding to an estimated mortality of −58%. Intensive multidisciplinary management, including emergency cesarean delivery for acute fetal distress, led to a favorable outcome with the birth of a healthy infant at term. The second case concerned a 39-year-old multigravida with mucosal PV, diagnosed based on clinical presentation and indirect immunofluorescence (IIF) in the absence of biopsy, DIF, and ELISA testing. She relapsed in the first trimester after discontinuing corticosteroids, later complicated by intrauterine growth restriction (IUGR). Both maternal remission and neonatal recovery were achieved after resumption of systemic corticosteroid therapy. Discussion: TEN is a rare but life-threatening hypersensitivity reaction mediated by cytotoxic T cells, associated with significant maternal and fetal morbidity. PV is an autoimmune blistering disease caused by IgG anti-desmoglein antibodies; pregnancy may exacerbate disease activity, while transplacental antibody transfer can occasionally result in neonatal pemphigus. In both conditions, therapeutic options are limited during pregnancy, necessitating individualized multidisciplinary management. In resource-limited settings, structured pharmacovigilance with simplified adverse drug reaction reporting may help reduce preventable morbidity. Conclusion: TEN and PV during pregnancy are rare but serious conditions requiring prompt recognition, tailored therapy, and coordinated obstetric-dermatologic-neonatal care. Expanding diagnostic access and clinician awareness is critical to improving maternal-fetal outcomes.