A Case of Bullous Pemphigoid with Hypothyroidism Caused by Hypopituitarism
DOI:
https://doi.org/10.12970/2310-998X.2014.02.02.1Keywords:
Bullous pemphigoid, hypothyroidism, hypopituitarism.Abstract
A case of bullous pemphigoid with hypothyroidism caused by hypopituitarism is reported. The patient had a history of brain infarction six years ago. Over three months, tense vesico-bullous eruptions developed on her whole body. Histopathology revealed subepidermal blisters with dense eosinophil infilitrations. A direct immunofluorescent study found deposition of IgG and C3c components in the basement membrane zone. A blood examination showed greatly elevated titer of BP 180 antibody. Based on clinical, histopathological and laboratory findings, the patient was diagnosed as bullous pemphigoid. In our examination of endocrine functions, reduced levels of ACTH, TSH, FT3, FT4 and aldosterone were found, suggesting hypothyroidism caused by hypopituitarism. After the patient was treated by corticosteroid pulse therapy (methylpredonisolone 500mg/d with tapering), the lesions improved. Neurological examination showed lacuna infarction in the brain. We reported a case with bullous pemphigoid with hypothyrodism caused by hypopituitarism.
References
Langan SM, Groves RW, West J. The relationship between neurological disease and bullous pemphigoid: a population-based case-control study. J Invest Dermatol 2011; 131: 631-6. http://dx.doi.org/10.1038/jid.2010.357
Tsuruta D, Nishikawa T, Yamagami J, Hashimoto T. Unilateral bullous pemphigoid without erythema and eosinophil infiltration in a hemiplegic patient. J Dermatol 2012; 39: 787-9. http://dx.doi.org/10.1111/j.1346-8138.2012.01562.x
Dickmann U, Ritter G, Kretzschmar H. Pemphigoid and cerebral infarct. Syntropy of 2 diseases? Case report. Nervenarzt 1986; 57: 309-10.
Ujiie H, Shibaki A, Nishie W, et al. A novel active mouse model for bullous pemphigoid targeting humanized pathogenic antigen. J Immunol 2010; 184(4): 2166-74. http://dx.doi.org/10.4049/jimmunol.0903101
Foureur N, Descamps V, Lebrun-Vignes B, et al. Bullous pemphigoid in a leg affected with hemiparesia: a possible relation of neurological diseases with bullous pemphigoid? Eur J Dermatol 2001; 11: 230-3.
Prabhakar VK, Shalet SM. Aetiology, diagnosis, and management of hypopituitarism in adult life. Postgrad Med J 2006; 82: 259-66. http://dx.doi.org/10.1136/pgmj.2005.039768
Callen JP, McCall MW. Bullous pemphigoid and Hashimoto's thyroiditis. J Am Acad Dermatol 1981; 5: 558-60. http://dx.doi.org/10.1016/S0190-9622(81)70116-6
Lynfield YL, Green K, Gopal R. Bullous pemphigoid and multiple autoimmune diseases. Alopecia universalis, bullous pemphigoid, hypothyroidism, rheumatoid arthritis, and neutropenia in one patient. J Am Acad Dermatol 1983; 9: 257-61. http://dx.doi.org/10.1016/S0190-9622(83)80358-2
