Maternal pemphigus vulgaris with in vivo bound antibodies in the stillborn fetus

A 42-year-old black woman, gravida V, para IV, developed a recurrence of pemphigus vulgaris in the third trimester of pregnancy. She delivered a 2,056-gm stillborn female fetus in the seventh month, 2 days after ultrasonography had demonstrated absence of fetal cardiac activity and other evidence of intrauterine fetal death. The macerated fetus had peeling of its skin and an intact bulla on the foot. Fetal cardiac blood, obtained after delivery, showed the presence of pemphigus antibodies at a titer of 20. Direct immunofluorescence of fetal skin demonstrated IgG in the epidermal intercellular spaces. Autolytic changes of the skin, however, precluded definitive histologic documentation of acantholytic disease.