Use of Intravenous Immunoglobulin in the Treatment of Pemphigoid Gestationis: A Case Report

Gestational pemphigoid is a rare autoimmune skin condition specific to pregnancy and the postpartum period, with a variable course. There are currently no standardized guidelines referring to evidence-based therapeutic strategies. Intravenous immunoglobulin (IVIG) has recently emerged as a safe and effective steroid-sparing option as a second-line treatment for cases refractory to conventional steroid therapy and for managing relapses. We present the case of a 36-year-old primigravida patient diagnosed with gestational pemphigoid who initially had a difficult clinical course despite treatment with high-dose oral steroids. A first cycle of IVIG combined with steroids (with a gradual dose tapering regimen) was administered, showing initial clinical improvement. However, the patient experienced a relapse that required a new increase in steroid dose and interruption of pregnancy due to fetal growth restriction. Given persistent disease activity at the first outpatient follow-up, a combination of oral steroids with a gradual dose tapering regimen, along with a new cycle of IV immunoglobulin and azathioprine, was initiated, leading to complete resolution by the 19th week of outpatient follow-up. No adverse effects associated with IVIG were reported during the course of follow-up.