Shakhashiro Muna, Bradley Taylor R, Tobin Stuart
Dermatology, University of Kentucky College of Medicine, Lexington, USA.
Dermatology, Lexington Veterans Affairs (VA) Health Care System, Lexington, USA.
Cureus. 2023 Sep 11;15(9):e45037. doi: 10.7759/cureus.45037. eCollection 2023 Sep.
Bullous pemphigoid (BP) is one of the most common autoimmune blistering diseases and classically presents as large, tense bullae. We report a case of BP with toxic epidermal necrolysis (TEN)-like manifestations in a 103-year-old male, the oldest known patient to present with an acute onset of BP. Our patient presented with extensive erosive lesions comprising 12% of the total body surface area, raising suspicion of TEN and Staphylococcal scalded skin syndrome. Detailed clinical, histological, and immunofluorescence analyses were performed, confirming a diagnosis of BP. Atypical presentations of blistering disorders can be a diagnostic challenge and require the use of histologic and direct immunofluorescence testing to distinguish between clinically similar cutaneous diseases. Proper diagnosis is essential to ensure appropriate management and patient care.
大疱性类天疱疮（BP）是最常见的自身免疫性水疱病之一，典型表现为大的、紧张性水疱。我们报告一例103岁男性的BP病例，其具有中毒性表皮坏死松解症（TEN）样表现，是已知急性起病的BP患者中年龄最大的。我们的患者出现广泛的糜烂性皮损，占体表面积的12%，这引发了对TEN和葡萄球菌性烫伤样皮肤综合征的怀疑。进行了详细的临床、组织学和免疫荧光分析，确诊为BP。水疱性疾病的非典型表现可能是诊断上的挑战，需要使用组织学和直接免疫荧光检测来区分临床相似的皮肤病。正确诊断对于确保适当的管理和患者护理至关重要。
