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A 40-year-old man with a medical history of ulcerative colitis presented with a 2-week history of a pruritic, bullous eruption (Figure 1). He reported that he had been taking 5-aminosalicylic acid for years and had not recently taken any new medications. Despite his young age, bullous pemphigoid was suspected clinically. A biopsy was performed and prednisone therapy was initiated.

Figure appears in full text version. Figure 1. Drug-induced bullous pemphigoid. Widespread, tense bullae on erythematous bases.

Routine hematoxylin-eosin staining revealed an eosinophil-rich, perivascular infiltrate and a subepidermal blister. Direct immunofluorescence studies revealed 2+ coalescing granular and linear IgG deposits along the basement membrane zone, 2+ coalescing granular and linear C3 deposits along the basement membrane zone, and faint deposits of C3 in the basal cell cytoplasm (Figure 2). These findings were interpreted as a "pemphigoid-like pattern, suggestive of drug-related etiology."

Figure appears in full text version. Figure 2. Drug-induced bullous pemphigoid. Intracytoplasmic and linear basement membrane zone deposition . . . [Full Text of this Article]

AUTHOR INFORMATION
Laura K. Ferris, MD, PhD; Drazen Jukic, MD, PhD; Joseph C. English III, MD; Matthew J. Zirwas, MD