Bullous pemphigoid presenting as dry gangrene in a revascularized limb.
Bullous pemphigoid (BP) is the most common autoimmune blistering disease, and has been associated with many diseases; most autoimmune. It has never previously been associated with a reperfused limb. A 74-year-old female underwent a right femoroanterior tibial polytetrafluoroethylene (PTFE) bypass for tissue loss and rest pain in the right foot. After surgery she was treated for recurrent infection which exacerbated tissue loss and was eventually diagnosed as BP. There was a delay in diagnosis due to the similarity to dry gangrene. This case highlights the potential difficulties of BP diagnosis in a revascularized limb and the importance of multidisciplinary management of atypical infection.
Twine
Christopher P
CP
Department of Vascular Surgery, University Hospital of Wales, Cardiff, United Kingdom. chris_twine@hotmail.com
Malik
Gauhar
G
Street
Sarah
S
Williams
Ian M
IM
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000601:surgery*; D001706:Biopsy; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D003951:Diagnostic Errors; D005260:Female; D005734:Gangrene; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000601:surgery*; D035002:Lower Extremity / Q000098:blood supply*; D017895:Manganese Compounds / Q000627:therapeutic use; D010087:Oxides / Q000627:therapeutic use; D010391:Pemphigoid, Bullous / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D011239:Prednisolone / Q000627:therapeutic use; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D005938:Glucocorticoids; D017895:Manganese Compounds; D010087:Oxides; C048856:permanganic acid; D011239:Prednisolone