Bullous pemphigoid and ulcerative colitis

A 21-year-old white woman, who had ulcerative colitis for 14 years, developed generalized severe bullous pemphigoid. Following the resection of her colon, her skin showed marked clinical improvement, but this was only temporary. Direct immunofluorescence was performed on the surgical specimen and no antibodies (BMZ) to colonic mucosal cells were evident. Anti-basement membrane zone antibodies were found on direct and indirect immunofluorescent studies and have persisted. Sera from 15 patients with ulcerative colitis and 11 patients with Crohn's disease, evaluated for the presence of an anti-basement membrane zone antibody did not contain any demonstrable levels of anti-BMZ antibodies. The co-existence of ulcerative colitis and bullous pemphigoid is more likely incidental rather than etiopathologic.