Abstract
A 66-year old man, having been diagnosed and treated as psoriasis vulgaris for more than 15 years was admitted to our hospital because of sudden appearance of severe swelling, scales and erythema on almost entire body and accompanied with fever at 39 degrees centigrade. We started treatment with oral etretinate 75 mg daily, improving systemic symptoms and erythema dramatically. However after tapered it to 20mg daily, tense systemic bullae appeared. Histopathologically, there were subepidermal bullae including eosinophils. Direct immunofluorescent test showed linear deposition of immunoglobulin G and C3 at the basement membrane zone. Indirect immunofluorescent test using normal control skin and patient sera revealed that patient sera included IgG type antibody (minimum concentration;1:160). Indirect immunofluorescent test using normal human skin split by 1M sodium chloride showed that patient sera reacted on the epidermal side. Immunoblot analysis disclosed that the patient sera reacted with bullous pemphigoid antigen of 180kDa. Enzyme-linked immunosorbent assay showed that patient sera was precipitated by recombinant BP180 protein. From these analyses, we diagnosed this patient as bullous pemphigoid accompanied with pustular psoriasis. Combination therapy of etretinate (20mg daily) and cyclosporin (1.5mg/kg daily) gave improvement on his eruption. He is controlled by cyclosporin (1.5mg/kg daily) only, and keeps stable condition.
