A Widespread Pruritic Blistering Eruption in a Young Female

A 26-year-old previously healthy, non-pregnant female presented with a 1-week history of a highly pruritic blistering eruption predominantly affecting the trunk and upper limbs. This was preceded by a viral upper respiratory tract illness for which she had taken oral ibuprofen some 2 weeks prior. Clinical examination revealed multiple tense bullae on an erythematous base arranged in some areas in a "string-of-pearls" distribution, with sparing of the mucosa. Laboratory studies showed raised inflammatory markers and marked peripheral eosinophilia. Serology identified high-titre antibodies directed against the NC16A domain of BP180 by enzyme-linked immunosorbent assay (ELISA), and histopathological examination demonstrated a subepidermal blister with an eosinophil-rich infiltrate, together with linear IgG and C3 deposition along the basement membrane zone on direct immunofluorescence. This case illustrates an uncommon autoimmune blistering disorder presenting in a young adult, potentially triggered by viral infection and ibuprofen exposure, achieving sustained remission with rituximab.