Journal of Health and Medical Sciences
ISSN 2622-7258
Published: 29 October 2022
Bullous Pemphigoid in a 37-Year Old Female: A Case Report and Literature Review
Stefon Monique D. Oxley, Brian M. Denney
Chong Hua Hospital Department of Internal Medicine (Philippines), Cebu Velez General Hospital (Philippines)
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10.31014/aior.1994.05.04.246
Pages: 55-60
Keywords: Bullous Pemphigoid, Female, Case Report
Abstract
Bullous pemphigoid is a blistering disorder which mainly affects the geriatric population predominantly older than 70 years. It is caused by an autoimmune reaction to the hemidesmosomal proteins in basal keratinocytes, causing an inflammatory cascade and subsequent bullae formation. It is rarely encountered in infants, children, and middle-aged adults. Herein, a case of Bullous pemphigoid in a 37-year old female patient is reported. The patient presented with a three-month history of multiple serous fluid-filled tense blisters on the face, neck, trunk, flexor and extensor surfaces of the extremities up to the lower thigh, with areas of excoriation, peeling, erosion and crusting. No involvement of the mucous membranes noted. The lesions were associated with intense pruritus and pain upon rupture. Patient had no other subjective complaints and had an unremarkable past medical history. Patient was initially treated with antibiotics but noted no improvement in her condition. Histologic evaluation of the skin was done and revealed a subepidermal vesicular dermatitis with prominent neutrophilic infiltrates. No hyphae or spores were seen. With these findings, patient was admitted and treated with systemic steroids, antibiotics, and antipruritic medications. Direct Immunofluorescence was done and yielded findings consistent with the diagnosis of Bullous Pemphigoid. The overall response of the patient to therapy was satisfactory. The differentiation of Bullous pemphigoid from other subepidermal bullous diseases is important due to the potential of systemic manifestations and complications of the other diseases. The importance of clinical, histopathologic and immunologic findings in confirming the diagnosis of Bullous Pemphigoid is highlighted in this case report.
References
Baroero, L., Coppo, P., Bertolino, L., Maccario, S., & Savino, F. (2017). Three case reports of post immunization and post viral Bullous Pemphigoid: looking for the right trigger. BMC pediatrics, 17(1), 60. https://doi.org/10.1186/s12887-017-0813-0
Bourdon-Lanoy, E., Roujeau, J. C., Joly, P., Guillaume, J. C., Bernard, P., Prost, C., Tancrède-Bohin, E., Delaporte, E., Picard-Dahan, C., Albes, B., Bedane, C., Doutre, M. S., Chosidow, O., Lok, C., Pauwels, C., Chevrand-Breton, J., Sassolas, B., & Richard, M. A. (2005). Pemphigoïde du sujet jeune [Bullous pemphigoid in young patients: a retrospective study of 74 cases]. Annales de dermatologie et de venereologie, 132(2), 115–122. https://doi.org/10.1016/s0151-9638(05)79220-6
Kang, S., Amagai, M., Bruckner, A.L., Enk, A.H., Margalis, D.J., McMichael, A.J., & Orringer, J.S. (2019). Fitzpatrick dermatology. New York, NY: McGraw-Hill Education.
Kridin, K., & Ludwig, R. J. (2018). The Growing Incidence of Bullous Pemphigoid: Overview and Potential Explanations. Frontiers in medicine, 5, 220. https://doi.org/10.3389/fmed.2018.00220
Lee, C. M., Leadbetter, H. K., & Fishman, J. M. (2015). A case of oropharyngeal bullous pemphigoid presenting with haemoptysis. Case reports in otolaryngology, 2015, 631098. https://doi.org/10.1155/2015/631098
Miyamoto, D., Santi, C. G., Aoki, V., & Maruta, C. W. (2019). Bullous pemphigoid. Anais brasileiros de dermatologia, 94(2), 133–146. https://doi.org/10.1590/abd1806-4841.20199007
Parellada, J., Olivera Arencibia, Y., Watson, H., Parellada, N., Saikaly, L. E., & Saikaly, S. K. (2018). A Case of Bullous Pemphigoid: A Prevalent and Potentially Fatal Condition. Cureus, 10(4), e2533. https://doi.org/10.7759/cureus.2533
Rawson, K., Vinod, S., Sreenivasan, B., & Roy, G. (2018). Drug-induced bullous pemphigod – a case report with review. Journal of Indian Academy of Oral and Medicine Radiology, 30(4), 427-431. doi:10.4103/jiaomr.jiaomr_126_18
Sravyasruthi, P., Swetha, K.R., Saranya, P.V., Pranusha, M., Madhavi, V., Ranganayakulu, D. (2018). A case report on bullous pemphigoid. EC Pharmacology and Toxicology, 6(6), 411-413. Retrieved February 23, 2020 from https://www.ecronicon.com/ecpt/pdf/ECPT-06-00178.pdf
Tan, S.K. & Tay, Y.K. (2018). Bullous pemphigoid: profile and outcome in a series of 100 cases in singapore. Journal of Dermatology and Dermatologic Surgery, 22, 12-15. doi: 10.4103/jdds.jdds_1_18
Zanella, RR., Xavier, T.A., Tebcherani, A.J., & Sanchez, A.P.G. (2011). Bullous pemphigoid in younger adults: three case reports. Anais Brasileiros de Dermatologia, 86(2). https://doi.org/10.1590/S0365-05962011000200023