Multiple Sclerosis and Bullous Pemphigoid

Abstract

3 patients with multiple sclerosis (MS) who developed severe widespread bullous pemphigoid (BP) are presented. MS preceded the presentation of BP by 13–23 years (mean 18 years). BP was confirmed histologically and immunopathologically. Upon successful therapy with steroids, no recurrence of BP was observed over a 3–5 year (mean 3.7 years) follow-up. Several abnormalities of the immune system have been reported in both diseases. It is interesting to speculate that amidst existing immunologic abnormalities in all 3 patients with MS, a specific event, immunologic or viral or both may have triggered the development of BP.

Bullous Pemphigoid and Amyotrophic Lateral Sclerosis

“…As a matter of fact, various chronic neurological disorders have been reported in association with BP, eg, multiple sclerosis, [1][2][3][4][5][6][7][8][9][10][11] posttraumatic (Jean-Claude Roujeau, MD, personal communication, 1991) or ischemic paresia, 18,19 and Shy-Drager syndrome, 20 suggesting that these diseases share a feature able to induce the bullous disease. The role of drugs should be considered.…”

“…When it was specified (in at least 14 of 18 patients), all had long-standing, advanced multiple sclerosis with chronic definitive paresia. [1][2][3][4][5][6][7][8][9][10][11] Lastly, our patients with BP had limb function that was much more altered than that in the total ALS population.…”

“…An autoimmune process has been suggested to explain the association of BP with multiple sclerosis. [1][2][3][4][5][6][7][8][9][10][11] To our knowledge, this is the first report of an association of BP with amyotrophic lateral sclerosis (ALS).…”

Multiple Sclerosis and Autoimmune Skin Bullae: A Case of Pemphigus vulgaris

“…Sir, We were very interested to read the report by Simjee et al [1] of three cases of bullous pemphigoid (BP) complicating the evolution of multiple sclerosis (MS). In thesethree cases, which toour knowledge constitute the three unique descriptions of such an association in the literature, the age group is younger than the usual age group affected by BP (i.e., 49, 62 and 35 years of age) and the skin condition healed rapidly and durably with short administrations of corticosteroids (i.e., 6 and 8 months, respectively, in two cases after initiation at 1 mg/kg/day, and in the third case local applications of O.l'i'o triamcinolone only).…”

“…Simjee et al [1] recall the possible role of viruses as a trigger for either the initiation or the maintenance of both MS and BP. A similar effect of viruses has been proposed for PV [3].…”