Title:Drug-aggravated Bullous Pemphigoid in a 47-year-old Asian Woman -
A Case Report
Volume: 18
Issue: 3
Author(s): Divyajayashree Nelramachandrakumar, Haritha Hariharan, Senthilvel Nagamanickam and Sam Johnson Udaya Chander J.*
Affiliation:
- College of Pharmacy, Sri Ramakrishna Institute of Paramedical Sciences, Coimbatore, Tamil Nadu, India
Keywords:
Autoimmune disease, bullous pemphigoid, folk medicine, erythematous blister, exaggeration, sepsis.
Abstract:
Introduction: Bullous pemphigoid is the most common chronic recurrent autoimmune
subepidermal blistering disorder most prevalent in the geriatric population. It varies widely in clinical
presentation ranging from tense bullae to intense generalized pruritus. It is immunologic in
origin with the presence of IgG antibodies.
Case Report: A 47-year-old female presented to the hospital with complaints of blisters in the lower
limbs, which she self managed with neem oil, after which the blisters occurred over the body.
The patient also experienced blisters over both upper and lower limbs, gluteal region, painful generalized
ulcers, necrotic patches, multiple erythematous blisters, ulcer erosions over bilateral legs
and upper limbs with few lesions, which were foul-smelling and oozing. On the second day of admission,
the patient’s CRP and ESR levels were tested and the levels were 33.5 and 35 mm/hr, respectively.
The patient was treated with an injection of meropenem 1 g three times daily, dexamethasone
4 mg once daily, and ofloxacin 400 mg once daily. On the third day of admission, the patient
complained of leg swelling, and subsequently, D-Dimer levels were checked, which showed a
value of 5,740 and was treated with an injection of enoxaparin 40 mg for the same throughout the
course of the hospital stay A skin biopsy confirmed the diagnosis of bullous pemphigoid. The culture
test showed the growth of Klebsiella pneumonia and Acinetobacter baumani, which were resistant
to most of the antibiotics. The patient was managed appropriately with modalities including
antibiotics, anti-inflammatory agents, immunosuppressants, multivitamins, fluids, and albumin.
The patient responded well to the treatment without new lesions or fever spikes. There was the
presence of necrotic patches of old lesions alone at the time of discharge.
Conclusion: This case report was done with the purpose of presenting an exemplary case of
bullous pemphigoid aggravated by the application of neem oil and emphasizing the inappropriate
use of folk medicine in an autoimmune disease like bullous pemphigoid.
