Cases Of Bullous Pemphigoid Research Articles

Dipeptidyl peptidase 4 inhibitors linked bullous pemphigoid in patients with type 2 diabetes mellitus: A series of 13 cases

BackgroundDipeptidyl peptidase 4 (DPP4) inhibitors have increasingly been linked to bullous pemphigoid, but there is paucity of data from India where about 1.85 million patients have been estimated to use these drugs. MethodsIn 30,000 patients with T2DM seen by us in two tertiary care centres since 2015, we detected 13 cases of bullous pemphigoid linked to DPP4 inhibitors. We used WHO-UMC (World Health Organisation-Uppsala Monitoring Centre) causality assessment system for assessment. ResultsLesions of bullous pemphigoid appeared at varied intervals (within 1 weeks–2 years) after start of DPP4 inhibitors. Implicated drugs were Linagliptin (n, 8), Vildagliptin (n, 4) and Sitagliptin (n, 1). Mostly, lesions were seen after 60 years age, and over trunk and extremities. Skin biopsy was compatible with bullous pemphigoid in two patients. Lesions regressed within a month of stopping DPP4 inhibitors in 9 patients while delayed regression up to 6 months in 4 patients. Overall, skin lesions remitted in all patients and did not recur. ConclusionAny new bullous lesion appearing while patient is on DPP4 inhibitors should be considered as bullous pemphigoid and should necessitate prompt withdrawal of the drug.

Bullous pemphigoid: can it occur in pediatric age?

Bullous pemphigoid in children is extremely infrequent, with no prevalence or incidence data in medical literature. Most of them predominate in elderly persons, resulting fundamental to consider that in medicine everything could be possible, and this disease could occur in children, so we must pay special attention to its clinical manifestations, to take the appropriate exams and in this way perform an effective treatment at the precise moment. Following, we present a clinical case of bullous pemphigoid that occurred in a pediatric patient attended at our university hospital.

Furosemide induced bullous pemphigoid: a case report

Bullous pemphigoid is an acquired autoimmune disease characterized by subepidermal vesicles and bullae. The etiology is mostly idiopathic with the highest occurrence in elderly patients. However, it is now well-accepted that bp has been triggered by or associated with drug therapy. Over 50 agents have been implicated as a cause of Drug-induced bullous pemphigoid, including diuretics, ace inhibitors, and antibiotics. We present a case of Bullous pemphigoid in a 75 year old male probably induced by furosemide. A 75 year old male was admitted to the dermatology department of KIMS hospital, Bengaluru. Presented with multiple tense bullae and vesicles over both upper limbs, forearm and few collapsed bullae and vesicles over the extensor aspect of forearm. Patient had a past history of myocardial infarction and undergone coronary artery bypass grafting for the same and treated with multiple medications. Among the treatment given injection furosemide was the one of the drug, after which he developed lesions and also presented with fluid filled bullae. A diagnosis of bullous pemphigoid was made based on clinical history and was treated with prednisolone, halobetasol and antibiotics. The lesions improved significantly with the above management and patient recovered enough to be discharged from the hospital after 5 days. Severe and serious reactions such as bullous pemphigoid can be caused by used drugs like furosemide.

A Clinicopathological Study of Immunobullous Diseases

BACKGROUND Vesiculobullous disorders are a group of disorders involving the formation of a fluid filled cavity within or beneath the epidermis, due to the presence of autoantibodies against adhesion molecules in epidermis and dermis. The clinical presentation and the microscopic features of different diseases belonging to this group vary greatly. This study was undertaken to describe the clinical features and the histopathological patterns of immunobullous diseases. METHOD 30 cases of immunobullous disorders who attended Dermatology Outpatient Department were included in the study. Relevant clinical details of these cases were collected and punch biopsies were taken from the site of lesion which were used for routine histopathology. RESULTS Among the 30 cases included in our study, males were found to be more commonly affected than females. The most common immunobullous lesions encountered were Pemphigus Vulgaris(13/30) and Bullous Pemphigoid (10/30). In pemphigus group of diseases, patients presented with small cutaneous and oral vesicles. Pemphigus foliaceous patients showed cutaneous lesions only. Intraepidermal vesicles containing acantholytic cells and inflammatory cells were characteristic histological features of the Pemphigus group. Bullous pemphigoid lesions were large bullae on the limbs and within the oral cavity. Most of the cases of Bullous Pemphigoid showed the formation of subepidermal bullae predominantly containing eosinophils. CONCLUSION Both the clinical findings and the histological features are invaluable in arriving at a definite diagnosis in immunobullous diseases.

Association between bullous pemphigoid and psoriasis: Systematic review and meta-analysis of case-control studies.

Several case reports and cohort studies have recently investigated the potential association between bullous pemphigoid (BP) and psoriasis. It has been speculated that chronic inflammation in the dermo-epidermal junction can trigger exposure to antigens to autoreactive T cells, resulting in autoimmune blistering disease. However, the association described has been inconsistently reported amongst studies. We performed a systematic review and meta-analysis to investigation this potential association. We identified four case-control studies for inclusion in the present meta-analysis, with a total of 4035 bullous pemphigoid cases and 19 215 control cases. There was a significantly higher prevalence of psoriasis in BP compared to controls (2.6% vs 1.1%, OR 2.5, 95% CI 1.4-4.6). Subgroup analysis showed that this association remained significant in both males (3.0% vs 1.3%, OR 2.4, 95% CI 1.6-3.6) as well as females (1.9% vs 0.7%, OR 2.9, 95% CI 1.4-5.9). A significantly higher proportion of cases were reported in males (3.0% vs 1.9%, OR 1.75, 95% CI 1.1-2.7). This pooled analysis of existing case-control studies to date demonstrates a significant association between BP and psoriasis. We also showed that in contrast with the majority of autoimmune diseases which are predisposed in females, that the coexistence of BP and psoriasis appears to be predisposed in male patients.

A rare case of bullous pemphigoid associated with esophageal involvement and acquired hemophilia

A rare case of bullous pemphigoid associated with esophageal involvement and acquired hemophilia

A Case of Bullous Pemphigoid Complicated with Necrotizing Cellulitis of the Foot Successfully Treated with Concurrent High-dose Intravenous Immunoglobulin Therapy

A Case of Bullous Pemphigoid Complicated with Necrotizing Cellulitis of the Foot Successfully Treated with Concurrent High-dose Intravenous Immunoglobulin Therapy

Association between bullous pemphigoid and malignancy: A meta-analysis.

It has been suggested that bullous pemphigoid is associated with an increased risk of malignancy, but the evidence is inconsistent. Therefore, a meta-analysis was conducted to explore this association. PUBMED and Embase were searched for studies investigating the association between bullous pemphigoid and malignancy. This meta-analysis included 16 studies with a total of 9398 cases of bullous pemphigoid. The rate of malignancy in patients with bullous pemphigoid was 11% (95% CI: 9-14, P<0.001); 9% (95% CI: 6-13, P<0.003) for women and 13% (95% CI: 9-18, P<0.03) for men, with a statistically insignificant higher risk in men (OR=1.30, 95% CI: 0.99-1.71, P=0.06). The event rate was 9% (95% CI: 5-14, P<0.001) in the Asian population and 13% (95% CI: 10-17, P<0.001) in the European population, with a statistically significant lower risk in the Asians population (OR=0.69, 95% CI: 0.57-0.84; P<0.001). The event rate of malignancy was higher in patients with bullous pemphigoid than in matched controls (OR=2.08, 95% CI: 1.22-3.55; P=0.005). The overall event rate of malignancy was higher in the bullous pemphigoid group than in matched controls. Caution is required when interpreting these results, as potential confounding variables were not controlled for.

A Case of Bullous Pemphigoid with a Low-grade Appendiceal Mucinous Neoplasm

症例は79歳，女性．水疱性類天疱瘡に対しプレドニン30mgを内服中にT-SPOT陽性であったため，結核の鑑別目的に胸腹部CTを施行したところ，回盲部に辺縁明瞭平滑な6cm大の低濃度腫瘤を認めた．腹部症状は無く，採血ではCEAが高値を示していた．虫垂粘液腫や虫垂癌を疑い，回盲部切除術（D2郭清）を行った．病理組織学検査所見は，上皮部分に低異型度の腫瘍性の高円柱状の上皮細胞が小乳頭状に嚢胞内腔に向かって突出していた．嚢胞壁は固有筋層が不明瞭になり，菲薄な線維性結合組織のみからなる部位が多く，低異型度虫垂粘液腫瘍と診断した．類天疱瘡に悪性腫瘍を合併することは多いが，虫垂原発腫瘍を合併した症例報告はない．今回，水疱性類天疱瘡の経過観察中に低異型度虫垂粘液腫瘍を併発した症例を経験したので，文献学的考察を加えて報告する．

A Case of Bullous Pemphigoid with a High Titer of Anti-BP180 NC16a IgG Antibody

Aim: Our Rehabilitative Center joined a Surgical Center, active in the same part of Tuscany, in order to prime fast recovery model. The aim of the present study is to verify the trend of the fore mentioned ongoing project compared with the earlier rehabilitative treatment regarding patients who have undergone the same kind of total knee arthroplasty. Design: The study is retrospective and focuses on a plurality of factors. Setting: Surgical and rehabilitative facilities' location, patients with knee prosthesis were considered. Population: Patients with knee prosthesis (right and left) operated in elective surgery in surgical and rehabilitative facilities' location who underwent 'Standard' or Recovery rehabilitation for seven days, also patients that decided to stay in rehabilitation for more than seven days by their own decision. Methods: The first hypothesis wants to prove that the clinical-rehabilitative improvements gained with Rapid Recovery, are more significant (or at least equal) than those gained with the standard treatment. It exist a positive and statistically significant correlation (Pearson's indicator) between the clinical-rehabilitative results based on the incoming and outcoming variations of the IKSS scale (considered as primary outcome measure) and the variations of other scales: we mean to demonstrate such a positive correlation. We intend to demonstrate that 7 days of rehabilitation are necessary and sufficient to achieve significant therapeutic results. Results and conclusion: It is possible to say that improvements with a rehabilitation program are linked to improvements in everyday life ability's recovery. The improvements that have been found in group 3 differ significantly with group 2. A hospitalization longer than 7 days appears definitely positive and patients experience a further improvement. Notwithstanding, it can be stated that a 7 days hospitalization might be sufficient to achieve a result compatible with a return home in autonomy.

A case of bullous pemphigoid associated with the administration of ipragliflozin, a sodium-glucose cotransporter 2 inhibitor

A case of bullous pemphigoid associated with the administration of ipragliflozin, a sodium-glucose cotransporter 2 inhibitor

Two Cases of Bullous Pemphigoid Induced by Vildagliptin

Two Cases of Bullous Pemphigoid Induced by Vildagliptin

A case of bullous pemphigoid confined to umbilical region suspect of fixed drug eruption.

A case of bullous pemphigoid confined to umbilical region suspect of fixed drug eruption.

Case of bullous pemphigoid accompanied by collagenous gastroenteritis

Case of bullous pemphigoid accompanied by collagenous gastroenteritis

A case of bullous pemphigoid which shows negative serum anti-BP180 antibody by commercial ELISA

A case of bullous pemphigoid which shows negative serum anti-BP180 antibody by commercial ELISA

Bullous pemphigoid and antecedent neurological diseases: An association with dementia.

Bullous pemphigoid is the most common subepidermal immunobullous disorder. Studies have reported the association between bullous pemphigoid and various neurological diseases. The aim of this study was to evaluate whether bullous pemphigoid is associated with pre-existent neurological diseases and whether specific diseases exhibit this association. All dermatology inpatients from January 2010 to May 2015 were analyzed. Bullous pemphigoid cases were identified based on clinical features and consistent histopathologic and direct immunofluorescence findings. Patients with other autoimmune bullous skin disorders were excluded. An equal number of inpatients with other skin conditions were selected randomly as age- and sex- matched controls. Out of 3015 inpatients, 103 cases of bullous pemphigoid and 103 age- and sex-matched controls were included. Seventy six patients with bullous pemphigoid had a history of at least one neurological disease. After adjusting for age, gender, race, functional status and neuro-psychiatric medications, patients with bullous pemphigoid were found to be approximately thrice as likely to have a history of at least one neurological disease than were controls (odds ratio: 2.88; 95% confidence interval: 1.32-6.26; P = 0.008). Amongst the pre-existing neurological diseases, only dementia was statistically more prevalent in bullous pemphigoid cases compared to controls (adjusted odds ratio: 2.61; 95% confidence interval: 1.19-5.75; P = 0.017). Parkinson disease and psychiatric disorders demonstrated a higher adjusted risk among bullous pemphigoid patients but the difference was not statistically significant. The limitations were potential referral and selection bias, as the patients were inpatients. There is a possible misclassification as the diagnosis of neurological diseases was performed using medical records. The duration from the diagnosis of neurological diseases to bullous pemphigoid could not be accurately determined as it was a retrospective review of records and most neurological diseases have a prolonged course. Pre-existent neurological disease, specifically dementia, was found to be associated with bullous pemphigoid.

A Case of Bullous Pemphigoid Diagnosed by Oral Hemorrhage

A Case of Bullous Pemphigoid Diagnosed by Oral Hemorrhage

A case of bullous pemphigoid due to long-term oral administration of valsartan

A case of bullous pemphigoid due to long-term oral administration of valsartan

Periodic Acid-Schiff Staining Parallels the Immunoreactivity Seen By Direct Immunofluorescence in Autoimmune Skin Diseases.

Background:In many countries and laboratories, techniques such as direct immunofluorescence (DIF) are not available for the diagnosis of skin diseases. Thus, these laboratories are limited in the full diagnoses of autoimmune skin diseases, vasculitis, and rheumatologic diseases. In our experience with these diseases and the patient's skin biopsies, we have noted a positive correlation between periodic acid-Schiff (PAS) staining and immunofluorescence patterns; however, these were just empiric observations. In the current study, we aim to confirm these observations, given the concept that the majority of autoantibodies are glycoproteins and should thus be recognized by PAS staining.Aims:To compare direct immunofluorescent and PAS staining, in multiple autoimmune diseases that are known to exhibit specific direct immunofluorescent patterns.Materials and Methods:We studied multiple autoimmune skin diseases: Five cases of bullous pemphigoid, five cases of pemphigus vulgaris, ten cases of cutaneous lupus, ten cases of autoimmune vasculitis, ten cases of lichen planus (LP), and five cases of cutaneous drug reactions (including one case of erythema multiforme). In addition, we utilized 45 normal skin control specimens from plastic surgery reductions.Results:We found a 98% positive correlation between DIF and PAS staining patterns over all the disease samples.Conclusion:We recommend that laboratories without access to DIF always perform PAS staining in addition to hematoxylin and eosin (H&E) staining, for a review of the reactivity pattern.

水疱性類天疱瘡を発症した血液透析患者の1例

水疱性類天疱瘡を発症した血液透析患者の1例