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Bullous pemphigoid-like lesions induced by phenacetin. Report of a case and an immunopathologic study
Abstract:
An 84-year-old man with chronic eczema and ischemic heart disease had bullous pemphigoid-like lesions develop following the oral administration of phenacetin. The diagnosis was confirmed by routine histopathologic studies and by immunofluorescent and electron microscopy. Since rechallenge with phenacetin resulted in bulla formation, phenacetin was considered to be the causative agent. This patient showed several atypical clinical features, compared with patients with idiopathic bullous pemphigoid, including no associated erythematous macules, a positive Nikolsky's sign, painful superficial ulcers, and nonpruritic bullae. Histopathologically, there was lack of polymorphonuclear leukocyte infiltrate. The immunopathologic characteristics, however, were quite typical for those found in bullous pemphigoid. The antigenic sites for the autoantibodies from our patient were, at least in part, different from those of idiopathic bullous pemphigoid.
Insights
Phenacetin triggered bullous pemphigoid-like lesions in an elderly man. This drug-induced condition presented atypical clinical and immunopathologic features compared to idiopathic bullous pemphigoid.
Area of Science:
- Dermatology
- Immunology
- Pharmacology
Background:
- Bullous pemphigoid (BP) is an autoimmune blistering disease.
- Drug-induced variants of BP can mimic the idiopathic form.
Observation:
- An 84-year-old male with eczema and ischemic heart disease developed bullous pemphigoid-like lesions after oral phenacetin.
- Rechallenge with phenacetin confirmed it as the causative agent.
- The patient exhibited atypical clinical features, including a positive Nikolsky's sign and superficial ulcers.
Findings:
- Histopathology revealed a lack of polymorphonuclear leukocyte infiltrate.
- Immunofluorescence showed typical bullous pemphigoid characteristics.
- Autoantibody binding sites differed partially from idiopathic bullous pemphigoid.
Implications:
- Phenacetin can induce bullous pemphigoid-like lesions with unique clinical and immunopathologic profiles.
- This case highlights the importance of considering drug-induced causes in atypical blistering diseases.
- Further research is needed to understand the specific antigenic targets in phenacetin-induced bullous pemphigoid.