Cetuximab-induced bullous pemphigoid
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Pemphigoid group of dermatologic conditions is a group of autoimmune skin disorders resulting in blistering skin conditions. The two diseases that fall under this category are bullous pemphigoid and pemphigus vulgaris. While there are many similarities in these two disorders, there are numerous pathologic and biochemical differences which help us differentiate between these disorders. In this case report, we report a usual manifestation of bullous pemphigoid in a 72-year-old female secondary to use of a well-known antihypertensive (hydrochlorothiazide) and/or venlafaxine (anti-depressant).
Pemphigus vulgaris
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Bullous pemphigoid (BP) is the most common autoimmune bullous disease, but rarer forms of pemphigoid may appear identical to BP on routine histopathology and direct immunofluorescence (DIF). Here, we present the case of a 60-year-old man, who was initially thought to have BP, with supportive findings on routine histopathology and DIF. However, prominent oral involvement and cutaneous lesions refractory to conventional treatment suggested an alternate diagnosis. Further workup was performed, including indirect immunofluorescence (IIF) on salt-split skin, which showed binding of antibodies to the dermal floor rather than to the blister roof, and enzyme-linked immunosorbent assay for pemphigus and pemphigoid antibodies. With these additional tests, we concluded that the patient does not have BP but rather anti-p200 pemphigoid, anti-p105 pemphigoid, or a yet undiscovered form of pemphigoid. We reached a presumptive diagnosis of anti-p200 pemphigoid, as it is the most common pemphigoid with serum antibodies to the dermal floor of human salt-split skin by IIF. This case demonstrates that suspicion for other autoimmune bullous diseases in cases of treatment-refractory and clinically aberrant BP is essential. A limited workup may lead to a missed diagnosis and ultimately less efficient disease management.
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Paraneoplastic pemphigus
Histopathology
Direct fluorescent antibody
Cicatricial pemphigoid
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Direct fluorescent antibody
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Several diseases may be confused with scabies. Atypical manifestations of scabies have previously been reported, including urticaria, contact dermatitis, and dermatitis herpetiformis. There are also reports of scabies mimicking bullous pemphigoid. Here we report a case of scabies in a patient with manifestation similar to bullous pemphigoid. Direct smear of the bullous lesions was performed and was positive for scabies mites. The skin biopsy specimens submitted for light microscopy and direct immunofluorescence study were considered to be compatible with bullous pemphigoid. The patient treated with single dose oral ivermectin and prednisolone. The pruritus subsided and the eruption improved dramatically in 2 weeks.
Dermatitis herpetiformis
Skin biopsy
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A case of localized pemphigoid is described in which the lesions were only on the lower legs. Immunoblotting of the patients' serum reacted with a 240‐kDa polypeptide identical to one of the bullous pemphigoid antigens. IgG1 was detected in the lesional skin and IgG1 and IgG4 in the patient's serum. These observations suggest that the immunopathological mechanisms in the blister formation in localized pemphigoid are similar to those found in more widespread bullous pemphigoid.
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Epidermolysis bullosa acquisita
PUVA therapy
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There have been several reports in the literature of coexistent psoriasis and bullous pemphigoid. In most cases,the bullous pemphigoid lesions have been considered to be induced by antipsoriatic treatments. We describe a patient with psoriasis in whom bullous pemphigoid developed during psoriasis treatment, but the exact etiologic factor was not identified. Recently, some reports have suggested that an immunologic or biochemica1 association between the two diseases plays a role in the pathogenesis. (Ann Dermatol 11(1) 23~26,1999).
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摘要： 患者男，40岁，因全身红斑伴痒2年，加重4个月，双手足水疱1周就诊。患者2年前无明显诱因下出现躯干、四肢红斑丘疹，伴瘙痒，红斑消退后遗留色素沉着……
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