2003 Volume 65 Issue 4 Pages 324-328
Case 1: A 78-year-old man had a 10-year history of multiple itchy nodules with histological features of prurigo nodularis, and he also suffered from several blisters on his extremities for the past 3 months with features of bullous pemphigoid. Direct immunofluorescense studies of prurigo nodularis and BP lesions showed linear depositions of IgG and C3 at the basement membrane zone (BMZ). Circulating IgG against the BMZ was also detected by indirect immunofluorescense. The patient’s serum was found to contain an antibody against the 230kD bullous pemphigoid antigen. The blisters and nodules cleared soon after oral prednisolone (30mg/day) was started. Case 2: A 77-year-old woman had a history of prurigo nodularis for 5 or 6 years, and blisters of bullous pemphigoid for 2 months. Direct immunofluorescense studies showed linear depositions of IgG and C3 at BMZ. Circulating IgG against the BMZ was also detected by indirect immunofluorescense. The patient’s serum was shown to contain antibodies against the 180kD bullous pemphigoid antigen and the 230kD bullous pemphigoid antigen. Although the blisters cleared after treatment with oral prednisolone (30mg/day), some eruptions of prurigo nodularis still remained. Considering the previous reports, it seems typical that prurigo nodularis lesions appear first and BP lesions develop later. In the diagnosis process of pemphigoid nodularis, it is important that both BP and prurigo nodularis appear at some period of the disease history, together with the immunofluorescence findings. Due to advances in the overall knowledge of bullous pemphigoid antigen, further discussions about the diagnosis, examination and treatment of pemphigoid nodularis are needed.
