Successful induction treatment of bullous pemphigoid using reslizumab: a case report

Abstract

Background: Bullous pemphigoid (BP) is a potentially life-threatening autoimmune blistering disease which is characterized by autoantibodies against hemidesmosomal proteins of the skin and mucous membranes. In recent years, the role of eosinophil and immunoglobulin E autoantibodies have been further elucidated in BP, and have been considered potential therapeutic targets.

Case presentations: A 67-year-old male presented with erythematous bullous eruption. The skin eruption was located on whole body, and suggested BP. Peripheral blood eosinophil count and total immunoglobulin E markedly elevated in initial laboratory findings. Topical and systemic steroid (methylprednisolone 2 mg/kg/day) treatment was started, and his skin symptoms worsened repeatedly, whenever systemic steroid were reduced. On admission day 29, reslizumab (anti-interleukin-5) 3.5 mg/kg was administered intravenously to the patients. The bullous skin lesion began to improve rapidly, and methylprednisolone (8 mg/day) was reduced without any worsening of symptoms during two doses of reslizumab.

Conclusions: We report a case of successful treatment response to reslizumab administration in a patient with BP. Further studies are needed to confirm the role of anti-interleukin-5 as a treatment for BP in the future.

Keywords: Bullous pemphigoid; Corticosteroid; Eosinophil; Reslizumab.

Fig. 1

Image showing a skin lesion suggestive of bullous pemphigoid (A on admission day). No improvement in the skin lesion is observed during steroid treatment (B on admission day 14). Significant improvement in the lesion is observed after the administration of reslizumab [C on the day of discharge (day 14 after admission)]

Fig. 2

Histopathological examination of the patient. subepidermal bulla with perivascular inflammatory cell infiltration with some eosinophils were shown in histologic examination of a skin biopsy of a bullous lesion on the abdomen (A H&E:  × 364). Direct immunofluorescence showing granular deposits of complement C3 along the basement membrane (B  × 100)