Successful treatment of a severe persistent case of pemphigoid gestationis with antepartum and postpartum intravenous immunoglobulin followed by azathioprine

We report a case of pemphigoid gestationis affecting a 37-year-old woman in both her pregnancies. In her second pregnancy she failed to respond to high-dose oral prednisolone. She was treated successfully with intravenous immunoglobulin (2 g/kg each infusion cycle) as a steroid-sparing agent during both the antepartum and postpartum period. The baby was born at the 36th week of gestation. No complications were noted for either mother or baby. After ceasing intravenous immunoglobulin, azathioprine (up to a dose of 1 mg/kg/day) was used to adequately control her pemphigoid gestationis.