Bullous pemphigoid as a manifestation of chronic lymphocytic leukemia

We describe a patient with chronic lymphocytic leukemia (CLL) and bullous pemphigoid. Initial treatment with high-dose prednisone (60 mg/day for 14 days) failed to prevent occurrence of new skin lesions. After the addition of chlorambucil, 6 mg/day, and tapering the prednisone dosage, no new skin lesions appeared, and the bullous lesions rapidly resolved. We were unable to isolate an antibody produced by leukemic lymphocytes that is directed against subepithelial basement membrane. Nevertheless, we believe that bullous pemphigoid can be a peripheral manifestation of an underlying disease such as CLL. Confirmation of this would be aided by the isolation of antibody produced by leukemic cells that is directed against subepithelial basement membrane.