New-Onset Bullous Pemphigoid in a COVID-19 Patient

Abstract

This manuscript presents a report of bullous pemphigoid rash associated with COVID-19 for the first time. The objective of this manuscript is to present a unique dermatological case in the setting of a COVID-19-positive infection to further recognize the virus symptomatology. A 37-year-old female with a past medical history of class III obesity, type II diabetes mellitus, and hypertension presented to the emergency department in September 2020 with inpatient and outpatient follow-up through to November 2020. The patient denied any personal or family history of skin disorders. The patient tested positive for COVID-19 prior to hospitalization and presented to the hospital with severe, persistent, pruritic rash meeting dermatopathological, serologic, and clinical criteria for bullous pemphigoid diagnosis. Histopathology H&E punch biopsy from her left flexor wrist demonstrated epidermal keratinocyte necrosis, subepidermal vesiculation with eosinophils, gossamer stranding of the papillary dermis, and subepidermal edema. Direct immunofluorescence punch biopsy from her left flexor wrist demonstrated strong linear IgG staining at the dermoepidermal junction, with weaker and focal linear C3 staining. Antigen-specific serology was consistent with bullous pemphigoid. There was no previously reported cutaneous association of COVID-19 infection with bullous pemphigoid making this case an important addition to the body of evidence helping to identify bullous pemphigoid in the setting of viral infection.

Cutaneous manifestations of Coronavirus Disease 2019

“…15 New-onset bullous pemphigoid and pemphigus vulgaris, the skin manifestations of the miscellaneous group, were reported in 2 and 1 patients, respectively; the findings that add into here through prior studies. 16 . 17 Very few of our patients had pernio-like lesions, which was contrary to previous reports.…”

Case Report: Infantile Bullous Pemphigoid: Triggering by COVID-19 Is Speculative

“…Autoimmune diseases concomitant with coronaviruses have been suggested to be associated with cross-reactivity of antibodies or activated lymphocytes with different antigens which own the same or similar epitopes ( 16 ). Two cases of pemphigus vulgaris following SARS-CoV-2 infection, as well as BP in an elderly female and a middle-aged female with COVID-19 were reported ( 17 – 20 ).…”

Patient Quality of Life Improvement in Bullous Disease: A Review of Primary Literature and Considerations for the Clinician

“…[50][51][52][53][54][55] In addition, flares and new-onset AIBD have been reported from natural COVID-19 infections. [56][57][58][59] Despite the small risk of disease onset or flare with vaccination, individual and public health benefits may outweigh this risk for most patients.…”