Bullous Pemphigoid With Nail Damage Associated With Kaposi Sarcoma: A Case Report

Abstract

Introduction: Bullous pemphigoid is an acquired autoimmune bullous skin disease that occurs in the elderly, and nail involvement is relatively rare. Kaposi sarcoma(KS) is a rare opportunistic tumor in patients with iatrogenic immunosuppression and is rarely associated with autoimmune bullotic disease. Here we reported of a 73-year-old female with bullous pemphigoid with nail damage and KS. Case presentation: The patient was diagnosed with bullous pemphigoid based on her history, bullous pemphigoid antibody, and skin pathological examination. And nail involvement occurred 20 days prior to the recurrence of the disease. Moreover, KS occurred during high-dose glucocorticoid therapy in this patient. Discussion: The patient was admitted to hospital because of a five-month history of erythema and blisters and a one-month history of nodules and plaques. The diagnosis of bullous pemphigoid was followed by treatment with glucocorticoids and intravenous gamma globulin. During treatment, the disease recurred due to discontinuation of glucocorticoids. There were erythema and blisters all over the body, and purple nodules, plaques appeared in the base of some blisters. Pathological examination of nodules was consistent with KS. In addition, nail involvement occurred 20 days before recurrence. The particularity of this case lies in the simultaneous occurrence of nail involvement, bullous pemphigoid, and KS. Conclusion: Patients with autoimmune bullous skin disease may suddenly develop abnormal nails, and such patients should be vigilant about recurrence of the disease. Doctors should be aware of the possibility of KS when rapidly progressing purplish red plaques or nodules appear in patients receiving high doses of corticosteroids or immunosuppressants.