Refractory Bullous Pemphigoid Leading to Respiratory Arrest and Successfully Treated With Plasmapheresis

Abstract

<h3>To the Editor.—</h3> Bullous pemphigoid has been reported in the eyes, nose, pharynx, larynx, vulva, urethra, and lung.^1-3No reference was found to bullous pemphigoid lesions on the epiglottis. We describe a patient with generalized skin lesions who subsequently developed respiratory arrest secondary to bullae on his larynx. <h3>Report of a Case.—</h3> A 61-year-old man was admitted for the treatment of tense bullae on erythematous bases involving the trunk, groin, and extremities. The patient complained of oral pain and difficulty swallowing without shortness of breath, but no oral lesions were seen. A skin biopsy specimen contained a subepidermal blister and direct immunofluorescence-showed IgG and C3 deposits at the basement membrane consistent with bullous pemphigoid. The split-skin examination showed the blister to be above the lamina lucida. Indirect immunofluorescence was positive for antibasement membrane antibodies with a titer of 1:320. After hospital admission, the patient was treated with methylprednisolone (100