title: Bullous pemphigoid in an elderly patient with myelodysplastic syndrome and refractory anemia coupled with excess of blast.
abstract: Bullous pemphigoid (BP) has a recognized association with solid organ tumors, but is relatively rare in hematological malignancies. We report a 67-year-old male who developed BP after being diagnosed with myelodysplastic syndrome and refractory anemia with excess of blast (RAEB). Skin biopsy elucidated sub-epidermal bulla using direct immunofluorescence, revealing linear C3 and IgG deposits along the basement membrane. His BP was recalcitrant to the conventional treatment and only responded to a combination of high dose oral prednisolone and azathioprine. The relative refractory nature of his condition and concurrent RAEB supports a paraneoplastic nature.
authors.affiliation: Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Yin Yin
authors.initials: YY
authors.lastname: Lee
authors.forename: Ping Chong
authors.initials: PC
authors.lastname: Bee
authors.forename: Chew Kek
authors.initials: CK
authors.lastname: Lee
authors.forename: Manimalar
authors.initials: M
authors.lastname: Naiker
authors.forename: Rokiah
authors.initials: R
authors.lastname: Ismail