Bullous Pemphigoid Causing Successive Emergency Department Visits

Area of Science:

• Dermatology
• Immunopathology
• Autoimmune Diseases

Background:

• Bullous pemphigoid (BP) is a rare autoimmune blistering disease affecting older adults.
• It involves autoantibodies targeting hemidesmosomal proteins, leading to basement membrane destruction and subepithelial bullae.
• The incidence of BP is increasing, with potential atypical presentations and drug associations.

Purpose of the Study:

• To present a case of bullous pemphigoid in an 84-year-old male with Fitzpatrick type IV skin.
• To illustrate the diagnostic and management challenges of bullous pemphigoid.
• To emphasize the importance of specialized dermatological care for refractory cases.

Main Methods:

• Case presentation of an elderly male with extensive blistering.
• Review of bullous pemphigoid pathophysiology and treatment guidelines.
• Description of clinical course including emergency department visits and hospitalization.

Main Results:

• The patient presented with widespread blistering on extremities, chest, and back.
• Initial treatments did not resolve symptoms, necessitating further outpatient dermatology care.
• The case underscores the potential severity and chronicity of bullous pemphigoid.

Conclusions:

• Bullous pemphigoid can present with severe, widespread blistering requiring intensive management.
• Prompt diagnosis and specialized dermatological intervention are crucial for effective treatment.
• This case highlights the importance of considering bullous pemphigoid in elderly patients with unexplained blistering.