Bullous Pemphigoid
An intact bullous lesion was found on the leg of an 84-year-old woman who had a three-day history of itching and blister formation on her thighs, arms, and legs. The remainder of the examination was unremarkable, and the results of routine laboratory tests were normal except for a finding of mild leukocytosis. The patient had been in good health and was taking no medications. An indirect immunofluorescence test for circulating antibasement antibodies was positive. The patient was hospitalized and treated with intravenous methylprednisolone and systemic antibiotics for secondary cellulitis. After three days, both the blisters and the cellulitis began to abate, and three weeks later, the patient's leg had resumed its normal appearance. Because of a mild disease flare after tapering and discontinuation of corticosteroids, the patient required maintenance therapy with low doses of prednisone. Jeffrey M. Levine, M.D. source: nejm.org
