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Review
. 2017 Feb;14(1):288-292.
doi: 10.1111/iwj.12670. Epub 2016 Oct 17.

Development of bullous pemphigoid during the haemodialysis of a young man: case report and literature survey

Katarzyna Osipowicz  1 , Agnieszka Kalinska-Bienias  1 , Cezary Kowalewski  1 , Katarzyna Wozniak  1
Affiliations
Review

Development of bullous pemphigoid during the haemodialysis of a young man: case report and literature survey

Katarzyna Osipowicz et al. Int Wound J. 2017 Feb.

Abstract

Haemodialysis is the most frequent form of renal replacement therapy (RRT) in patients with end-stage renal disorder (ESRD). Patients with ESRD frequently develop skin problems, mainly xerosis, pruritus and hyperpigmentation, as well as bullous diseases, mainly porphyria or pseudoporphyria and, in some cases, bullous pemphigoid (BP). BP is the most common autoimmune sub-epidermal blistering disease, and it predominantly affects elderly people. Clinically, BP is characterised by generalised pruritic, bullous eruptions and urticaria-like lesions. Usually, BP is an idiopathic disorder; however, in some cases, underlying internal disorders are present, like diabetes or neurological disorders. Herein, we present a 33-year-old man with ESRD, maintained on haemodialysis, who developed BP. There are only six cases with BP provoked by the placement of a fistula for haemodialysis. BP in the current patient was confirmed by direct immunofluorescence (DIF) and indirect immunofluorescence using BIOCHIP. The patient responded promptly to tertracycline and 0·05% clobetasol propionate lesionally. However, the relationship between BP and the fistula for haemodialisys still remains unknown. It is highly likely that the skin injury associated with fistula placement was responsible for the alteration of the basement membrane zone (BMZ) and the stimulation of the immune system, leading to BP development. To explain the real role of fistula placement as a provocative factor in BP, other such cases are required for assessment.

Keywords: BIOCHIP; Bullous pemphigoid; Fistula; Haemodialysis; Renal allograft.

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Figures

Figure 1
Figure 1
Clinical characterisation of the current patient. (A) Tense blisters located on the forearms before treatment, (B) after treatment.
Figure 2
Figure 2
BIOCHIP: reactivity of circulating IgG with (A) the epidermal side of the salt split skin and (B) recombinant NC16a domain of the BP180 BMZ antigen.
See this image and copyright information in PMC

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