Multiple sclerosis and bullous pemphigoid: a casual association or a pathogenetic correlation?

The literature reports about thirty cases of bullous pemphigoid (BP) which developed in patients affected by multiple sclerosis (MS), although a relationship between these two diseases has not yet been identified. We report two cases of female patients affected by MS who subsequently developed BP. Two women came to our observation because of the presence of a bullous dermatitis. One, aged 54, had been affected by rapidly evolving MS for three years while the other, aged 60, had been suffering from MS since the age of 43. The clinical suspicion of BP was confirmed by cytodiagnostic examination, histology and immunofluorescence. Parenteral steroid therapy produced a rapid improvement of the clinical picture in both cases with a relapse after one year. On the basis of the cases observed, in which BP appeared in the absence of known potential triggering causes, and following a revision of the literature, we agree with those authors who assert that the two diseases could, even though only sporadically, be correlated and we think that the neurological disease could be the cause of the manifestations through immunological pathogenetic mechanisms.