Bullous Pemphigoid: A Spontaneous Presentation in a Patient With Chronic Kidney Disease

Overview

Journal Cureus

Specialty Biomedical Engineering

Date 2022 Jul 13

PMID 35822137

Authors

Brett Brazen

Ariel Kidron

Zakaria Sheikh

Vikeerna Kamatgi

Sann Htoo

Affiliations

Soon will be listed here.

Abstract

Bullous pemphigoid (BP) is an autoimmune subepidermal blistering pathology characterized by the development of pruritic, tense bullae and blisters on the lower extremities, axilla, and trunk. Its dermatopathology entails autoantibodies that target hemidesmosomes located in the basement membrane. The disease typically manifests in individuals over 50 years old with a higher prevalence in patients with concurrent neurological or dermatological autoimmune diseases. In this report, we discuss a case of a 67-year-old male who presented with a one-month history of itchy blisters occurring bilaterally in the lower extremities. The manifestation of BP, its pathophysiology, and treatment modalities are explored, We also engage in a review of the relevant literature.

References

Wertenteil S, Garg A, Strunk A, Alloo A . Prevalence estimates for pemphigoid in the United States: A sex-adjusted and age-adjusted population analysis. J Am Acad Dermatol. 2018; 80(3):655-659. DOI: 10.1016/j.jaad.2018.08.030. View

Joly P, Roujeau J, Benichou J, Picard C, Dreno B, Delaporte E . A comparison of oral and topical corticosteroids in patients with bullous pemphigoid. N Engl J Med. 2002; 346(5):321-7. DOI: 10.1056/NEJMoa011592. View

Thoma-Uszynski S, Uter W, Schwietzke S, Hofmann S, Hunziker T, Bernard P . BP230- and BP180-specific auto-antibodies in bullous pemphigoid. J Invest Dermatol. 2004; 122(6):1413-22. DOI: 10.1111/j.0022-202X.2004.22603.x. View

Kumetz E, Meyerle J, Rivard S . Epidermolysis Bullosa Acquisita: A Case Report. Am J Case Rep. 2020; 21:e919432. PMC: 7193220. DOI: 10.12659/AJCR.919432. View

Di Lernia V, Casanova D, Goldust M, Ricci C . Pemphigus Vulgaris and Bullous Pemphigoid: Update on Diagnosis and Treatment. Dermatol Pract Concept. 2020; 10(3):e2020050. PMC: 7319750. DOI: 10.5826/dpc.1003a50. View

Parellada J, Olivera Arencibia Y, Watson H, Parellada N, Saikaly L, Saikaly S . A Case of Bullous Pemphigoid: A Prevalent and Potentially Fatal Condition. Cureus. 2018; 10(4):e2533. PMC: 6017127. DOI: 10.7759/cureus.2533. View

Fuertes de Vega I, Iranzo-Fernandez P, Mascaro-Galy J . Bullous pemphigoid: clinical practice guidelines. Actas Dermosifiliogr. 2013; 105(4):328-46. DOI: 10.1016/j.ad.2012.10.022. View

Ikeda M, Honda H, Kobayashi N, Onuma S, Matsumoto K, Akizawa T . Membranous glomerulonephropathy in a patient with bullous pemphigoid. CEN Case Rep. 2017; 6(1):50-54. PMC: 5438807. DOI: 10.1007/s13730-016-0243-0. View

Feng S, Lin L, Jin P, Wu Q, Zhou W, Sang H . Role of BP180NC16a-enzyme-linked immunosorbent assay (ELISA) in the diagnosis of bullous pemphigoid in China. Int J Dermatol. 2008; 47(1):24-8. DOI: 10.1111/j.1365-4632.2007.03531.x. View

10.

Cole E, DeGrazia T, Sun Y, Liu Y, Feldman R . Assessing Disease Outcome Measures in Bullous Pemphigoid on Standard-Of-Care Therapies. JID Innov. 2021; 1(4):100050. PMC: 8659387. DOI: 10.1016/j.xjidi.2021.100050. View

11.

Moro F, Fania L, Sinagra J, Salemme A, Di Zenzo G . Bullous Pemphigoid: Trigger and Predisposing Factors. Biomolecules. 2020; 10(10). PMC: 7600534. DOI: 10.3390/biom10101432. View

12.

Rhyou H, Han S, Nam Y . Successful induction treatment of bullous pemphigoid using reslizumab: a case report. Allergy Asthma Clin Immunol. 2021; 17(1):117. PMC: 8596938. DOI: 10.1186/s13223-021-00619-1. View

13.

Joly P, Benichou J, Lok C, Hellot M, Saiag P, Tancrede-Bohin E . Prediction of survival for patients with bullous pemphigoid: a prospective study. Arch Dermatol. 2005; 141(6):691-8. DOI: 10.1001/archderm.141.6.691. View

14.

Sitaru C, Dahnrich C, Probst C, Komorowski L, Blocker I, Schmidt E . Enzyme-linked immunosorbent assay using multimers of the 16th non-collagenous domain of the BP180 antigen for sensitive and specific detection of pemphigoid autoantibodies. Exp Dermatol. 2007; 16(9):770-7. DOI: 10.1111/j.1600-0625.2007.00592.x. View

15.

Ross E, Ahmed A . Bullous pemphigoid-associated nephropathy: report of two cases and review of the literature. Am J Kidney Dis. 1989; 14(3):225-9. DOI: 10.1016/s0272-6386(89)80076-9. View

16.

Vaillant L, Bernard P, Joly P, Prost C, Labeille B, Bedane C . Evaluation of clinical criteria for diagnosis of bullous pemphigoid. French Bullous Study Group. Arch Dermatol. 1998; 134(9):1075-80. DOI: 10.1001/archderm.134.9.1075. View

17.

Schmidt E, Obe K, Brocker E, Zillikens D . Serum levels of autoantibodies to BP180 correlate with disease activity in patients with bullous pemphigoid. Arch Dermatol. 2000; 136(2):174-8. DOI: 10.1001/archderm.136.2.174. View

18.

Arpita R, Monica A, Venkatesh N, Atul S, Varun M . Oral Pemphigus Vulgaris: Case Report. Ethiop J Health Sci. 2016; 25(4):367-72. PMC: 4762976. View