Bullous Pemphigoid Mimicking Cellulitis.

Area of Science:

• Dermatology
• Immunology
• Pathology

Background:

• Bullous pemphigoid (BP) is a common autoimmune blistering skin disease primarily affecting the elderly.
• Diagnosis relies on clinical presentation and immunopathologic findings from skin biopsies.
• Risk factors include genetics, environmental exposures, infections (e.g., hepatitis B/C, H. pylori), and medications (e.g., DPP-4 inhibitors).

Purpose of the Study:

• To describe a novel clinical presentation of bullous pemphigoid.
• To highlight the diagnostic challenges posed by unusual variants of BP.
• To report the first case of BP presenting with a cellulitis-like appearance.

Main Methods:

• Case report of a patient with a known history of bullous pemphigoid.
• Clinical assessment and diagnostic workup for a cellulitis-like presentation.
• Review of literature for unusual BP presentations.

Main Results:

• The patient presented with symptoms mimicking cellulitis, a presentation not previously documented in BP literature.
• Standard BP clinical features include pruritic plaques, tense bullae, and erosions, typically on the trunk and extremities.
• Unusual presentations encompass nonbullous forms, urticarial lesions, and vegetating lesions.

Conclusions:

• Bullous pemphigoid can exhibit diverse and atypical clinical manifestations.
• Cellulitis-like presentation is a rare variant of bullous pemphigoid that can challenge diagnosis.
• Awareness of unusual BP presentations is crucial for timely and accurate diagnosis and management.