Bullous pemphigoid is known to be one of the paraneoplastic skin manifestation associated with internal malignancies.
A 60-year-old male patient suffering from erythema and bulla of the body was diagnosed as bullous pemphigoid in 1991. In August, 1997 he was admitted to our hospital because of bloody stool. Endoscopic examination revealed rectal cancer. Thoracic CT and abdominal CT showed metastatic tumour both in the left lung and the liver. After rectal cancer was resected by Miles'method, both metastatic tumours were also resected. Dermatological symptoms were remarkably reduced after these treatment. Four months later, again bulla appeared simultaneously with the reccurence of liver metastasis. Resection of this lesion lead to an improvement in the skin manifestation.
It is reported that internal malignancies are found in 5 to 20% of bullous pemphigoid patients. Including this case, only 9 cases of rectal cancer associated with bullous pemphigoid have been reported domestically. The characteristics of these patients are that they are comparatively aged and that the bullas are detected before the cancer is found. Also, 5 out of 9 patients showed improvement in their dermatological symptoms after resecting or chemotherapy treatment against the cancer, as in this case too.
In conclusion, it is important to examine thoroughly for internal malignancies including lower gastrointestinal tracts, in bullous pemphigoid patients.
