Covid-19 dermatoses: Acral vesicular pattern evolving into bullous pemphigoid

Area of Science:

• Dermatology
• Infectious Diseases
• Immunology

Background:

• Bullous Pemphigoid (BP) incidence is increasing, particularly in the elderly.
• COVID-19 (SARS-CoV-2) has been linked to various dermatological manifestations.
• Pathogenesis of BP involves antigen mimicry and antibody cross-reactivity.

Observation:

• A case of prolonged COVID-19 presented solely with dermatological symptoms.
• The initial presentation included maculopapular exanthema and acral vesicular dermatitis.
• The condition evolved into classic Bullous Pemphigoid, confirmed by histological and serological tests.

Findings:

• This is the first reported case of Bullous Pemphigoid developing concurrently with COVID-19.
• The study suggests prolonged SARS-CoV-2 infection may trigger an autoimmune response targeting basement membrane antigens (BP180, BP230).
• Histological and immunofluorescence findings confirmed the diagnosis of BP.

Implications:

• Ongoing dermatological surveillance is crucial during the COVID-19 pandemic.
• Further data collection is needed to assess the incidence of BP in COVID-19 patients.
• This case highlights a potential, albeit rare, association between SARS-CoV-2 infection and autoimmune blistering diseases.