Medizinonline Medizinonline
  • News
    • News
    • Market & Medicine
  • Patients
    • Disease patterns
    • Diagnostics
    • Therapy
  • Partner Content
    • Dermatology
      • Atopic dermatitis and psoriasis news
      • Dermatology News
    • Diabetes
      • Dia-Month Club – Type 2 Diabetes
      • Diabetes in Motion
      • Diabetes Podcasts
    • Gastroenterology
      • IBD matters
      • Forum Gastroenterology
      • Ozanimod: ulcerative colitis
      • Reflux Update
    • Immunology
      • Primary immunodeficiency – exchange of experience
    • Vaccinate
      • Herpes zoster
    • Infektiologie
    • Neurology
      • EXPERT ULTRASONIC: Introduction to ultrasound-guided injection
      • MS News
      • MS Therapy in Transition
    • Oncology
      • Swiss Oncology in motion
    • Orthopedics
      • Osteoporosis in motion
    • Phytotherapie
    • Practice Management
      • Aargau Cantonal Bank
      • Claraspital
    • Psychiatry
      • Geriatric Psychiatry
    • Rheumatology
  • Departments
    • Allergology and clinical immunology
    • General Internal Medicine
    • Anesthesiology
    • Angiology
    • Surgery
    • Dermatology and venereology
    • Endocrinology and Diabetology
    • Nutrition
    • Gastroenterology and Hepatology
    • Genetics
    • Geriatrics
    • Gynecology
    • Hematology
    • Infectiology
    • Cardiology
    • Nephrology
    • Neurology
    • Emergency and intensive care medicine
    • Nuclear Medicine
    • Oncology
    • Ophthalmology
    • ORL
    • Orthopedics
    • Pediatrics
    • Pharmacology and toxicology
    • Pharmaceutical medicine
    • Phlebology
    • Physical medicine and rehabilitation
    • Pneumology
    • Prevention and health care
    • Psychiatry and psychotherapy
    • Radiology
    • Forensic Medicine
    • Rheumatology
    • Sports Medicine
    • Traumatology and trauma surgery
    • Tropical and travel medicine
    • Urology
    • Dentistry
  • CME & Congresses
    • CME continuing education
    • Congress Reports
    • Congress calendar
  • Practice
    • Noctimed
    • Practice Management
    • Jobs
    • Interviews
  • Log In
  • Register
  • My account
  • Contact
  • English
    • Deutsch
    • Français
    • Italiano
    • Português
    • Español
  • Publications
  • Contact
  • Deutsch
  • English
  • Français
  • Italiano
  • Português
  • Español
Subscribe
Medizinonline Medizinonline
Medizinonline Medizinonline
  • News
    • News
    • Market & Medicine
  • Patienten
    • Krankheitsbilder
    • Diagnostik
    • Therapie
  • Partner Content
    • Dermatology
      • Atopic dermatitis and psoriasis news
      • Dermatology News
    • Diabetes
      • Dia-Month Club – Type 2 Diabetes
      • Diabetes in Motion
      • Diabetes Podcasts
    • Gastroenterology
      • IBD matters
      • Forum Gastroenterology
      • Ozanimod: ulcerative colitis
      • Reflux Update
    • Immunology
      • Primary immunodeficiency – exchange of experience
    • Vaccinate
      • Herpes zoster
    • Infektiologie
    • Neurology
      • EXPERT ULTRASONIC: Introduction to ultrasound-guided injection
      • MS News
      • MS Therapy in Transition
    • Oncology
      • Swiss Oncology in motion
    • Orthopedics
      • Osteoporosis in motion
    • Phytotherapie
    • Practice Management
      • Aargau Cantonal Bank
      • Claraspital
    • Psychiatry
      • Geriatric Psychiatry
    • Rheumatology
  • Departments
    • Fachbereiche 1-13
      • Allergology and clinical immunology
      • General Internal Medicine
      • Anesthesiology
      • Angiology
      • Surgery
      • Dermatology and venereology
      • Endocrinology and Diabetology
      • Nutrition
      • Gastroenterology and Hepatology
      • Genetics
      • Geriatrics
      • Gynecology
      • Hematology
    • Fachbereiche 14-26
      • Infectiology
      • Cardiology
      • Nephrology
      • Neurology
      • Emergency and intensive care medicine
      • Nuclear Medicine
      • Oncology
      • Ophthalmology
      • ORL
      • Orthopedics
      • Pediatrics
      • Pharmacology and toxicology
      • Pharmaceutical medicine
    • Fachbereiche 26-38
      • Phlebology
      • Physical medicine and rehabilitation
      • Phytotherapy
      • Pneumology
      • Prevention and health care
      • Psychiatry and psychotherapy
      • Radiology
      • Forensic Medicine
      • Rheumatology
      • Sports Medicine
      • Traumatology and trauma surgery
      • Tropical and travel medicine
      • Urology
      • Dentistry
  • CME & Congresses
    • CME continuing education
    • Congress Reports
    • Congress calendar
  • Practice
    • Noctimed
    • Practice Management
    • Jobs
    • Interviews
Login

Sie haben noch keinen Account? Registrieren

  • Bullous pemphigoid: case report

Immuno-serological evidence led to the diagnosis

    • Cases
    • Dermatology and venereology
    • Education
    • RX
  • 2 minute read

An elderly patient with therapy-resistant exanthematous skin lesions was diagnosed with bullous pemphigoid on the basis of ELISA IgG antibody determination. Serological detection of BP180 has high diagnostic sensitivity and specificity. After inpatient systemic cortisone therapy, the patient was discharged to an outpatient setting.

Bullous pemphigoid occurs more frequently in older persons. Typical clinical manifestations include severe itching and bulging blisters, erosions and crusts. Mostly, only the skin is affected, mucosal involvement is rather rare [1]. Immunopathologically, IgG antibodies are directed against components of the epithelial basement membrane (BP 180 and 230 antigens). In direct immunofluorescence, linear deposition of IgG and/or C3 along the basement membrane is characteristic.

Medical history

This case involves a 69-year-old woman who has been suffering from therapy-resistant exanthema with a relapsing course for seven months. A massive deterioration has been observed for two weeks. Allergies are not known. Pre-existing conditions: Type 2 diabetes mellitus, arterial hypertension, adrenal adenoma. History of varicose vein surgery and hemithyroidectomy. Drug history: Jentadueto
®
, Exforge
®
, Diovan
®
, Trajenta
®
, Xyzal
®
. Rosuvastatin, Deflamate, Thyrex.

Clinic and pretherapies

Generalized exanthema, partly small papular, truncal. In the area of the lower and upper extremities bullae and vesiculae. Mucous membranes bland. No scaling, no mite detection. Darier sign negative. Itching that is more pronounced in the evening.

Pretherapies consisted of corticosteroid-containing topical preparations and antihistamines.

Suspected diagnosis and further procedure

The tentative diagnosis is autoimmune bullous dermatosis (bullous pemphigoid). DD Urticaria, M. Grover. The patient is admitted as an inpatient for further diagnostic clarification. Specimen excision for histology and direct immunofluorescence. Anti-BP180 IgG ELISA. Routi-ne laboratory: eosinophil granulocytes 0.69 (0.0-0.4 G/L); eosinophil granulocytes relative 8.3 (1-4%).   

Immunoserological examination findings

ELISA IgG antibody determination revealed the following:

  • BP180: 3.18 / BP230: 0.06 / DSG1: 0.22 / DSG3: 0.34 / Envoplakin: 0.40 / Collagen VII: 0.39
    (valid default range: neg < 1 > positive)

 

Photos: © Hietzing Clinic (A)

 

Diagnosis

Bullous pemphigoid. Serological detection of BP180 has a sensitivity of 89.8% and a specificity of 97.8% [2].

Therapy

Inpatient setting

  • Systemic cortisone therapy: methylprednisolone i.v. 60 mg/d at 90 kg bw (initial dose).
  • Due to blood glucose imbalance, reduction to methylprednisolone 10 mg/d
  • Doxycycline i.v.  initiated, continued by o.s.
  • Histakut i.v.
  • Local Dermovate
    ®
    ointment 2×/d, Xyzal
    ®
    if needed 1-2 ×/d

Outpatient setting

  • Continuing care with a specialist in private practice
  • Methylprednisolone 10 mg per os for further
  • 10 days, pantoprazole (as long as methylprednisolone therapy), vibramycin
    ®
    100 mg 1×/d, Xyzal
    ®
    1-2×/d if needed.

 

Contact:

Doz. Dr. Paul-Gunther Sator, M.Sc
1st Senior Physician of the Skin Department, Hietzing Clinic
Wolkersbergenstrasse 1, A-1130 Vienna
paul.sator(a)gesundheitsverbund.at

 

Literature:

  1. AWMF: S2k guideline. Diagnosis and Therapy of Pemphigus vulgaris/foliaceus and Bullous Pemphigoid, 2019, www.awmf.org (last accessed Feb 05, 2021).
  2. EURIMMUN: Bullous Autoimmune Dermatoses, www.euroimmun.com/documents (last accessed Feb. 05, 2021).

 

 

DERMATOLOGY PRACTICE 2021; 31(1): 17

Publikation
  • DERMATOLOGIE PRAXIS
Related Topics
  • bullous pemphigoid
  • Derma cases
Previous Article
  • Continuing education series on type 2 diabetes

(2021) Dia-Month Club Module 6: Consequential diseases

  • CME continuing education
  • Education
  • Endocrinology and Diabetology
  • Partner Content
  • RX
  • Training with partner
View Post
Next Article
  • Sponsored Content: Spinal Muscular Atrophy

Growing evidence for nusinersen in adult patients with 5q SMA.

  • Neurology
  • RX
View Post
You May Also Like
View Post
  • 7 min
  • Moderate to severe chronic hand eczema

Delgocitinib cream – first topical pan-JAK inhibitor approved in Switzerland

    • Allergology and clinical immunology
    • Dermatology and venereology
    • Education
    • Infectiology
    • Market & Medicine
    • Pharmacology and toxicology
    • RX
View Post
  • 9 min
  • Wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CA)

Diagnosis at an early stage, prognostic classifications and outlook

    • Cardiology
    • Education
    • RX
    • Studies
View Post
  • 4 min
  • Case report: Drug-induced hepatitis

Rare side effect of tirzepatide therapy

    • Cases
    • Education
    • Endocrinology and Diabetology
    • Gastroenterology and Hepatology
    • Pharmacology and toxicology
    • RX
    • Studies
View Post
  • 4 min
  • Plea for sex-specific neurology

Migraine in men: underdiagnosed, underestimated, under-researched

    • Education
    • Neurology
    • RX
    • Studies
View Post
  • 4 min
  • Prurigo nodularis

Retrospective analyses of large data sets from everyday practice

    • Allergology and clinical immunology
    • Congress Reports
    • Dermatology and venereology
    • RX
View Post
  • 3 min
  • Public Health

Outpatient care in Switzerland: situation report

    • General Internal Medicine
    • Practice Management
    • Prevention and health care
    • RX
View Post
  • 5 min
  • Practice Management

Improved quality of care aims for satisfied patients

    • CME continuing education
    • General Internal Medicine
    • Practice Management
    • Prevention and health care
    • RX
    • Studies
View Post
  • 30 min
  • Chemsex - MSM, sex, chrystal meth & co.

Medical and psychosocial perspectives

    • CME continuing education
    • General Internal Medicine
    • Infectiology
    • Pharmacology and toxicology
    • Prevention and health care
    • Psychiatry and psychotherapy
    • RX
Top Partner Content
  • Forum Gastroenterology

    Zum Thema
  • Herpes zoster

    Zum Thema
  • Dermatology News

    Zum Thema
Top CME content
  • 1
    Patience, knowledge and persistence in therapy
  • 2
    Sarcopenia and malnutrition in the context of pneumological rehabilitation
  • 3
    Medical and psychosocial perspectives
  • 4
    New nomenclature for non-alcoholic fatty liver disease
  • 5
    Examinations and considerations before therapy

Newsletter

Sign up and stay up to date

Subscribe
Medizinonline
  • Contact
  • General terms and conditions
  • Imprint

Input your search keywords and press Enter.