Bullous Pemphigoid with Esophageal Involvement Presenting as Exfoliative Esophagitis and Acute Upper Gastrointestinal Bleeding: Reports of Two Cases and Review of the Literature

Bullous pemphigoid is the most common autoimmune blistering skin disease usually occurs in the elderly. The characteristic skin lesions present large and tense blisters arising on normal, erythematous, or urticarial bases and most commonly involve lower abdomen, inner thighs and flexural areas. The mucous membrane lesions occur in about 10 to 35 percent of patients and are almost limited to the oral mucous membrane. Esophageal involvement is a rare condition which may be completely asymptomatic or complicates with dysphagia and even life-threatening massive upper gastrointestinal bleeding. We present two cases of elderly patients with newly onset extensive bullous pemphigoid confirmed by pathological and immunofluorescence studies. One patient developed severe dysphagia. Endoscopy revealed diffuse exfoliative esophagitis and upper gastrointestinal hemorrhage; the other patient developed poor feeding and hematemesis aspirated from nasogastric tube and endoscopy showed multiple ulcers occurred on mid and lower esophagus. Both patients showed much improvement after systemic corticosteroid use.