Abstract
Impetigo herpetiformis, a dermatologic disorder occurring predominantly in the latter months of pregnancy, is frequently associated with severe maternal complications. We present a case of impetigo herpetiformis complicated by severe systemic inflammatory response syndrome (SIRS), in whom plasma cytokine and soluble adhesion molecule levels were determined.
The patient was a 26-year-old primigravida. At 35 weeks' gestation, the patient developed a severely pruritic pustular rash with pain, fever, and leukocytosis. Treatment commenced with an immediate child delivery by Cesarean section, intravenous administration of methyl prednisolone' and steroid ointment. Within 72 hours of delivery, there was marked improvement in the patient's general and skin conditions.
Plasma IL-6 and IL-1RA levels were elevated before the child delivery. Plasma pro- and anti-inflammatory cytokine levels decreased into the normal ranges on the Day 17 when the findings of SIRS were completely disappeared. The skin of the affected area showed intraepidermal pustules with an intensive neutrophilic infiltrate. Plasma level of IL-8, a chemokine which is known to induce neutrophil infiltration, was elevated before the child birth. Plasma sE-selectin and sICAM-1 levels were also elevated, reflecting increased gene expression of these adhesion molecules essential for the local accumulation of neutrophils. Plasma chemokine and soluble adhesion molecule levels decreased with resolution of the erythroderma and pustulation. These findings suggest that increased gene expression of cytokine, chemokine and adhesion molecules play an important role in the pathophysiology of SIRS as well as skin disorder of impetigo herpetiformis.
