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Background: The impact and clinical relevance of pregnancy-related heart failure (HF) on humoral immunity are not known. Heart failure is often characterized by immunoglobulins (Ig) that differ in subclass profile with etiology. Subclass immunoglobulins differ in the biologic information they confer in disease. Therefore, given that progressive gestation is associated with immunologic incompetence, we sought to study the relative impact of pregnancy-related onset of HF on humoral immunity., Methods: Immunoglobulins (class G and subclasses G1, G2, G3) against cardiac myosin were evaluated in 47 patients with peripartum cardiomyopathy (PPCM) from different global regions: South Africa (n = 15), Mozambique (n = 9), and Haiti (n = 23) and compared with healthy mothers and patients with idiopathic dilated cardiomyopathy (DCM). C-reactive protein, tumor necrosis factor-alpha, and Fas-Apo-1 were also studied in PPCMs., Results: All PPCM groups were similar in Ig profiles. The immunoglobulins, frequencies and reactivities, were markedly and nonselectively raised in PPCM patients compared with DCM. Immunoglobulin frequencies in PPCMs, Haiti: G1 58%, G2 66%, G3 54%; Mozambique: G1 77%, G2 66%, G3 66%; and South Africa: G1 47%, G2 53%, G3 53%, were higher compared with DCMs from South Africa (n = 24): G1 8%, G2 8%, G3 21%, or the United Kingdom (n = 68): G1 10%, G2 8.8%, G3 22% (P < .0001). Hence, unlike the selective up-regulation of immunoglobulins of the G3 subclass (IgG3s) in DCM, class G and all subclass immunoglobulins were raised in PPCM. Of the serological variables, IgG3s (immunoglobulins with proinflammatory characteristics) discriminated NYHA functional status at diagnosis. IgG3-positive patients were in a higher NYHA class at initial presentation (P < .05)., Conclusions: Immunoglobulin subclass profiles in patients with HF differ with etiology. Unlike DCM, the impact of pregnancy-related HF on humoral immunity is not subclass-restricted. However, raised levels of IgG3s may be of prognostic value in clinical PPCM.

The new onset of pemphigus in the postpartum period is exceedingly rare with only 1 case previously reported in the literature. We describe a 31-year-old woman who developed extensive denudation of her skin shortly after delivering her second child. Histologic examination, immunofluorescence testing, and immunoprecipitation with desmoglein 1 confirmed the diagnosis of pemphigus foliaceus. The patient responded to treatment with prednisone, cyclophosphamide, and plasmapheresis. The effect of the postpartum period on the onset and exacerbation of immune-mediated bullous diseases is discussed.

Herpes gestationis shares many features with other bullous diseases, especially bullous pemphigoid. Treatments of benefit in bullous pemphigoid may also be effective for herpes gestationis. Cyclophosphamide, azathioprine, and other immunosuppressive agents have been used successfully in refractory cases of bullous pemphigoid. We describe a patient with severe and persistent herpes gestationis in the postpartum period and the antiphospholipid antibody syndrome, both of which were refractory to high-dose corticosteroid therapy. Treatment with pulsed-dose intravenous cyclophosphamide produced an excellent clinical response.

Autoimmune progesterone dermatitis is a rare cutaneous disorder characterized by recurrent cyclic eruptions during the luteal phase of the menstrual cycle. We describe a woman with postpartum onset of a papulovesicular eruption. The possibility of autoimmune progesterone dermatitis was raised because of the cyclic nature of the outbreak. A reactive intradermal progesterone test confirmed the diagnosis. A review of individual case reports is also presented.