Abstract
A 46-year-old man noted erythema multiforme-like erythematous plaques on his trunk and extremities 13 days before the initial presentation. A tentative diagnosis of erythema exsudativum multiforme bullosum was made by a primary dermatologist, because they were associated with iris lesions. Prednisolone (PSL: 60-110 mg/day) was administered for 13 days, however, erythema and bullae spread over the entire body as was also associated by a continuous fever. The patient was then moved to our hospital. A physical examination revealed generalized erythema and multiple tense bullae. The eosinophil count was 14,500/μl. We diagnosed bullous pemphigoid (BP) based on the histological, immunohistological (direct immunofluorescence) and immunoblot analysis findings. Because PSL (1mg/kg/day) alone was not sufficiently effective in this case, we used azathioprine or cyclosporin A together with PSL and later tapered the dosage of PSL. This case is thus considered to meet the criteria of erythrodermic BP, which is an unusual variant of BP.
