Localized bullous pemphigoid overlying a fistula for hemodialysis

Pardo, José Ramón Paño; Rodríguez‐Serna, Mercedes; Mercader, Patricia; Fortea, José M.

doi:10.1016/j.jaad.2004.03.024

Cited by 28 publications

(25 citation statements)

References 5 publications

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“…In contrast to neurological disorders, the association of BP with renal insufficiency, renal transplantation or haemodialysis is not common. There are only several reports on this association in the literature . Although the pathogenic relationship between renal abnormalities and BP is not established, it is interesting that in some cases initial blisters typical of BP appeared on the skin of the forearm, where the fistula for haemodialysis was placed and closely related to the area of surgery, such as in our patient.…”

Section: Discussionmentioning

confidence: 64%

“…Herein, we present a young patient with ESRD treated with haemodialysis who developed BP. To date, there are only six such cases published in the literature, including ours, three females and three males (details in Table ) . These patients were of different ages when they developed BP; two of them were younger than 52 years of age, and four were 72 years and older.…”

Section: Discussionmentioning

confidence: 84%

“…One patient developed BP a short time after the placement of the fistula for haemodialysis , whereas in five patients, BP occurred 1–11 years later . Most of the patients had coexisting hypertension; two had diabetes mellitus; one had anaemia , and another had prostrate cancer and stroke in the anamnesis . In only two of them, it was possible to characterise the BP180 BMZ antigen as a target for circulating antibodies using immunoblot or BIOCHIP (our patient), which consists of different antigen substrates, allowing polyvalent immunofluorescence tests, and provides antibody profiles in a single incubation.…”

Section: Discussionmentioning

confidence: 97%

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

Osipowicz

Kalińska-Bienias

Kowaléwski

et al. 2016

International Wound Journal

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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.

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 97%

See 1 more Smart Citation

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

Osipowicz

Kalińska-Bienias

Kowaléwski

et al. 2016

International Wound Journal

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“…5 hemodialysis materials, and present clinical manifestations including itching, urticarial eruption, and blood eosinophilia. 6,7 To date, a few cases of BP [8][9][10][11][12] and pemphigoid nodularis 13 have been reported in patients treated with hemodialysis. Here we describe a case of BP, in which blood eosinophilia and bullous eruption appeared after the use of cellulose membrane for hemodialysis, and resolved after withdrawal of the membrane.…”

Section: Introductionmentioning

confidence: 99%

Development of bullous pemphigoid after change of dialysis membrane

Sodemoto

Yamahana

Echigo

et al. 2013

Hemodialysis International

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A 75-year-old Japanese man presented with pruritic blisters and macules on his trunk and extremities. He had been on hemodialysis for 4 years because of chronic renal failure, and in recent months, a polymethylmethacrylate membrane had been used for dialysis. After a change in dialysis membrane to a cellulose triacetate membrane, pruritic tense blisters developed on the extremities in combination with marked blood eosinophilia. Physical examination showed erythematous macules and tense blisters on the trunk and extremities. A biopsy specimen of an erythematous macule showed subepidermal vesicles and eosinophils that attached to the dermal-epidermal junction. Serum level of eosinophilic cationic protein was elevated. From clinical, histological, and immunological findings, a diagnosis of bullous pemphigoid was made. New blisters continued to erupt during the period in which the patient used the cellulose triacetate membrane dialyzer, and even after the use of clobetasol propionate. It resolved only after the patient came back to the use of a synthetic membrane dialyzer. We discontinued the use of clobetasol propionate, and neither bullous eruptions nor blood eosinophilia recurred. These observations suggest that cellulose membrane may be involved in the development of bullous pemphigoid through activation of eosinophils in the blood and the skin lesion, as in the present case.

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“…It occurs in four to six cases per million people per year, of which only a few involving localized BP have been reported to occur after surgery [1][2][3][4] and only one case of generalized BP devoloped after abdominal hernia surgery. [1] Herein, we report a case of generalized BP developing after femur fracture surgery.…”

mentioning

confidence: 99%