A Rare Case of Bullous Pemphigoid Triggered by Overlapping Immune Dysregulation From HIV and Hodgkin Lymphoma: A Case Report

Bullous pemphigoid (BP) is the most common autoimmune subepidermal blistering disorder, typically affecting elderly patients. Most cases are idiopathic, but BP has been reported to occur as a paraneoplastic phenomenon or in association with immune system abnormalities. We present a unique case of biopsy-confirmed BP in a 43-year-old man with advanced HIV infection (CD4 count: 4 cells/µL) and untreated classic Hodgkin lymphoma. The patient developed progressive tense bullae and desquamating skin lesions involving approximately 15% total body surface area, requiring debridement and subsequent transfer to a burn center for wound care. Laboratory studies demonstrated severe immunosuppression with a CD4 count of 4 cells/µL and pancytopenia. Histopathologic examination revealed subepidermal blistering with an eosinophil-rich infiltrate, and direct immunofluorescence showed linear deposition of IgG and C3 along the dermoepidermal junction. Serologic testing confirmed the presence of BP180 and BP230 autoantibodies. Management was complicated by the patient's immunosuppression, limiting the use of systemic corticosteroids and delaying wound healing. This case highlights an uncommon clinical intersection of BP, advanced HIV, and Hodgkin lymphoma.