Bullous Pemphigoid After Total Knee Arthroplasty

Abstract

Total knee arthroplasty is one of the safest and most routinely performed orthopedic procedures. As the volume of cases is expected to rise each year, so too will the incidence of uncommon complications. We describe a rare case of bullous pemphigoid, an autoimmune skin blistering disorder, that occurred after total knee arthroplasty in an otherwise healthy patient and led to hospital readmission. Early diagnosis and treatment of this condition may limit its spread and help to avoid comorbid sequelae.

Keywords: Blistering disorder; Bullous pemphigoid; Complications; Postoperative; Total knee arthroplasty (TKA).

Figure 1

Antero-posterior (a) and lateral (b) preoperative radiographs and antero-posterior (c) and lateral (d) postoperative radiographs.

Figure 2

Left medial leg 17 d after TKA, showing 20 tense, serous, and serosanguinous bullae and one erosion (a). Left medial leg 3 mo after TKA, showing postinflammatory hyperpigmentation (b).

Figure 3

Right (a) and left (b) ventrolateral trunk showing patchy erythema, diffuse wheals, and 10-15 overlying vesicles on his abdomen, flanks, and axillae. Excoriation and serous crusting can be observed over some lesions.