Abstract
The clinical diagnosis of bullous pemphigoid (BP) can be challenging given the polymorphic nature of the disease. We present a case of erythema multiforme (EM)-like BP in an 80-year-old woman with celiac disease. Skin biopsies showed intraepidermal and subepidermal bullae with direct immunofluorescence (DIF) demonstrating IgG and C3 linear deposition at the basement membrane. The etiology of our patient's BP is unclear but may be associated with furosemide usage and is temporally associated with a flare of celiac sprue. To our knowledge, only four other published cases document EM-like lesions in BP. Atypical presentations of BP should be confirmed with histology and direct immunofluorescence.
Highlights
The clinical diagnosis of bullous pemphigoid (BP) can be challenging given the polymorphic nature of the disease
She had coincident onset of diarrhea and vomiting which led to dehydration, renal failure, Figure 1: Left flank with erythematous targetoid plaques with dusky centers; forming areas of confluent erythema and coalesced tense vesicles
Multiple medications—citalopram, thioridazine, and flupenthixol—were suspected, none of which had previously been associated with BP [2]
Summary
The clinical diagnosis of bullous pemphigoid (BP) can be challenging given the polymorphic nature of the disease. An 80-year-old woman with celiac sprue presented with an acute bullous eruption on the bilateral flexural forearms. She had coincident onset of diarrhea and vomiting which led to dehydration, renal failure, Figure 1: Left flank with erythematous targetoid plaques with dusky centers; forming areas of confluent erythema and coalesced tense vesicles. The clinical diagnosis of bullous pemphigoid (BP) can be challenging in the setting of erythema multiforme (EM)-like lesions.
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