Bullous pemphigoid showing unusual ocular changes

We describe a 68-year-old Japanese woman with erythematous and bullous skin lesions. Antibasement membrane zone antibodies of IgG class were detected in the serum, which reacted with the 230 kDa and 180 kDa bullous pemphigoid antigens on immunoblot analysis. The patient later developed corneal opacity in both eyes and a detachment of the epithelium in the centre of the cornea. However, no change was seen in the conjunctiva. These ocular lesions are different from those of cicatricial pemphigoid. The ocular lesions could be reproduced by injection of IgG from this patient into the stroma of the corneas of rabbits. Both the cutaneous and ocular lesions responded well to oral corticosteroid therapy. We diagnosed this patient as having bullous pemphigoid associated with a unique ocular lesion.