Texas Tech University Health Sciences Center, Amarillo, TX, USA.
Amarillo VA Health Care System, Amarillo, TX, USA.
J Investig Med High Impact Case Rep. 2021 Jan-Dec;9:23247096211008585. doi: 10.1177/23247096211008585.
Bullous pemphigoid (BP) is the most prevalent autoimmune blistering skin disease in the Western world affecting mainly the elderly population. The diagnosis is based on clinical assessment along with specific immunopathologic findings on skin biopsy. Risk factors include genetic factors, environmental exposures, and several infections including hepatitis B, hepatitis C, , , and cytomegalovirus. A variety of drugs have been associated with BP including but not limited to dipeptidyl peptidase-4 inhibitors, loop diuretics, spironolactone, and neuroleptics. Associated neurologic disorders (dementia, Parkinson's disease, bipolar disorder, previous stroke history, and multiple sclerosis) have also been described. Common clinical presentation consists of extremely pruritic inflammatory plaques that resemble eczematous dermatitis or urticaria, followed by formation of tense bullae with subsequent erosions. Typical distribution involves the trunk and extremities. Mucosa is typically spared affecting only 10% to 30% of patients. Several unusual clinical presentations of BP have been described such as nonbullous forms with erythematous excoriated papules, plaques, and nodules. Other reported findings include urticarial lesions, prurigo-like nodules, multiple small vesicles resembling dermatitis herpetiformis or pompholyx, vegetating and purulent lesions localized in intertriginous areas, and even exfoliative erythroderma. Recognition and management of such cases can present a diagnostic challenge to clinicians. In this article, we describe another variant which to our knowledge is the first case to present with a cellulitis-like presentation in a patient with a known history of BP.
大疱性类天疱疮（BP）是西方世界最常见的自身免疫性水疱性皮肤病，主要影响老年人群。该诊断基于临床评估以及皮肤活检的特定免疫病理学发现。危险因素包括遗传因素、环境暴露和几种感染，包括乙型肝炎、丙型肝炎、、、和巨细胞病毒。许多药物与 BP 有关，包括但不限于二肽基肽酶-4 抑制剂、袢利尿剂、螺内酯和神经阻滞剂。还描述了与 BP 相关的神经障碍（痴呆、帕金森病、双相情感障碍、既往中风史和多发性硬化症）。常见的临床表现为极度瘙痒的炎症斑块，类似于湿疹性皮炎或荨麻疹，随后形成紧张性水疱，随后出现糜烂。典型的分布涉及躯干和四肢。黏膜通常不受影响，仅影响 10%至 30%的患者。已经描述了 BP 的几种不寻常的临床表现，例如非大疱性形式，表现为红斑性搔抓疹、斑块和结节。其他报道的发现包括荨麻疹样病变、瘙痒性结节、类似于疱疹样皮炎或汗疱疹的多形小水疱、局限于皱褶部位的化脓性病变和糜烂性红皮病。此类病例的识别和管理可能对临床医生构成诊断挑战。在本文中，我们描述了另一种变体，据我们所知，这是首例已知 BP 病史患者出现蜂窝织炎样表现的病例。
