title: Three case reports of post immunization and post viral Bullous Pemphigoid: looking for the right trigger.
abstract: Bullous pemphigoid (BP) is a blistering skin disorder infrequent in infancy and rarely reported in medical literature.
  
  
  
  Here we describe three cases of BP which were referred to our department in the last 15 years. Two of them developed an eruption of bullous lesions just a few days after vaccination for diphtheria, tetanus, pertussis, poliomyelitis, hepatitis B and Haemophilus influenzae B. The third patient developed the same blistering lesions shortly after herpetic stomatitis. In all three cases, clinical diagnosis was confirmed by histological examination which showed subepidermal bullae with a dermal inflammatory infiltrate, and direct immunofluorescence of perilesional skin showed linear IgG and C3 deposits along the basement membrane zone. Immunoblot assay was positive for BP antigen 180. Treatment with oral prednisone was instituted and the lesions resolved in two out of three patients; the third one was treated with an immunosuppressive agent (tacrolimus) and corticosteroid and subsequently with intravenous immunoglobulin and plasmapheresis, due to an underlying complex autoimmune disease.
  
  
  
  Although the mechanism of induction of BP is still unclear, the close relationship between trigger events (immunization or viral infection) and onset of the disease arises a possible association.
authors.affiliation: Dipartimento di Pediatria 1, Ospedale Infantile Regina Margherita, Regina Margherita Children's Hospital, Citta' della Salute e della Scienza di Torino, Piazza Polonia 94, 10126, Turin, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Baroero
authors.affiliation: Dipartimento di Pediatria 1, Ospedale Infantile Regina Margherita, Regina Margherita Children's Hospital, Citta' della Salute e della Scienza di Torino, Piazza Polonia 94, 10126, Turin, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Coppo
authors.affiliation: Dipartimento di scienze mediche, Università degli studi di Torino, Torino, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Bertolino
authors.affiliation: Pediatric Department, Chelsea and Westminster Hospital, London, UK.
authors.forename: Stefano
authors.initials: S
authors.lastname: Maccario
authors.affiliation: Dipartimento di Pediatria 1, Ospedale Infantile Regina Margherita, Regina Margherita Children's Hospital, Citta' della Salute e della Scienza di Torino, Piazza Polonia 94, 10126, Turin, Italy. francesco.savino@unito.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Savino
mesh_terms: D005260:Female; D006801:Humans; D007114:Immunization / Q000009:adverse effects*; D016756:Immunoglobulins, Intravenous / Q000008:administration & dosage* / Q000009:adverse effects; D007223:Infant; D008297:Male; D010391:Pemphigoid, Bullous / Q000175:diagnosis / Q000821:virology*; D012872:Skin Diseases, Vesiculobullous / Q000175:diagnosis / Q000209:etiology*
chemical_list: D016756:Immunoglobulins, Intravenous
keywords: Bullous Pemphigoid; Case report; Drug therapy; Infant; Vaccination