The VOICE of UPMC Shadyside Winter 2019–2020

When Your Bodyguard Blunders: Monica Abbott

Today, as autoimmune disorders affect more and more people, physicians at UPMC Shadyside provide life-changing care

Monica Abbott had a bad year in 2002. Her boyfriend was dying of pancreatic cancer, and she was spending every possible moment by his side. “I had so much stress,” she says. “I wasn’t eating. I was depressed. I lost a lot of weight. Apparently, my immune system was starting to go down.”

Next she caught a cold and could not get rid of it. “And then all of a sudden, I started getting blisters on my skin, especially in all the moist parts of my body, under my breasts and between my legs. I went to a clinic near my home, and the doctor told me I had chicken pox. But this went on for over a month and I’m breaking out in more blisters, and they are getting very painful.

“By Super Bowl Sunday in 2003, I was in agony. It felt like I was on fire from the inside out. I was in so much pain that I went to a hospital emergency room. At first no one knew what was wrong until one doctor said, ‘I know what this is. She is very, very sick. She might have 48 hours to live.’

“All my organs were starting to shut down,” Ms. Abbott continues.

What she had was a rare autoimmune skin disease: pemphigus (PEMM-fuh-gus). She was transferred by ambulance to UPMC Montefiore, where Timothy Patton, DO, who was just completing his residency at the University of Pittsburgh, began what has become 17 years of overseeing her pemphigus care. She credits him with saving her life.

“Nobody knew what was wrong with me. Then the doctor comes in and tells my family, ‘She might have 48 hours to live.’ ”
- Monica Abbott

Dr. Patton, who is now chief of Dermatology at UPMC Shadyside, finds it “intellectually challenging and rewarding to care for patients like Monica.

“When I was in medical school, what interested me most was studying rare, life-threatening skin diseases that required aggressive therapies,” he says. “Pemphigus is one of those. It is an immunobullous, or blistering, disease. While we do not know its exact cause, it is a condition in which the body will make antibodies that attack different proteins in the skin. Before the discovery of corticosteroids, pemphigus was 100 percent fatal. Essentially, patients just lose the function of the skin, because it winds up being replaced with these blisters and erosions. They become susceptible to infection.”

Because Ms. Abbott’s pemphigus had gone unrecognized for so long, it was particularly challenging to treat. She was hospitalized for more than three months, and controlling her symptoms took more than a year. She battled pain and exhaustion as flare-ups returned again and again. Many people thought she could not survive. She had to go to a burn unit for treatment of her blisters. She developed infections and a blood clot. Her bones deteriorated. She underwent apheresis, a procedure used to destroy harmful antibodies by removing blood, separating it into plasma and cells, and reintroducing the cells. She lost some of her hair. Even her vocal cords were affected.

“Although therapies are much better today, pemphigus may require long-term treatment to keep it in remission,” says Dr. Patton, who now directs the UPMC Center of Immunobullous Diseases. Patients travel long distances for care at this center of excellence, where treatment is aimed at reducing symptoms and preventing complications. It may include the use of cortico­steroids, immuno­suppressive drugs, and more recently immunotherapy.

Seventeen years after her diagnosis, Ms. Abbott is usually symptom free. Occasionally, though, when her skin begins to itch and blisters start, “I call Dr. Patton and go in to see him as fast as I can. He does blood work and checks out everything. Then I start my immunotherapy. I get two doses, one every other week.” The therapy is rituximab, a medication used to treat certain kinds of cancer as well as autoimmune diseases.

Born in Chile, Ms. Abbott came to the United States when she was five years old. She has worked hard all her life, most recently as a waitress, and has suffered illness and loss. Today the Carnegie resident is trying hard to watch her diet and control her stress. She enjoys the love of her sons and grandchildren as well as of her 92-year-old mother.

“It is a miracle that I’m alive today,” she says. “A miracle. And I owe it to Dr. Patton.”