The role of chronic infection foci and tumor process in the manifestation of bullous pemphigoid

Abstract

Bullous pemphigoid (BP) is the most common autoimmune subepidermal blistering dermatosis of the elderly, mediated by Th2-driven inflammation and autoantibodies to BP180/BP230. Its association with both malignant and chronic non-malignant diseases of the digestive system is increasingly discussed, but clinical correlations remain insufficiently characterized. In the first case, a 77-year-old man developed widespread BP shortly before the diagnosis of adenocarcinoma of the gastric antrum. Preoperative chemotherapy followed by subtotal gastrectomy resulted in complete and sustained remission of the skin disease until the patient died from postoperative sepsis. In the second case, a 56-year-old man with immunopathologic ally confirmed BP was found to have severe chronic calculous cholecystitis with a “non-functioning” gallbladder and hepatic steatosis. Initial disease control was achieved with systemic glucocorticoids, but definitive long-term remission occurred only after laparoscopic cholecystectomy and complete withdrawal of prednisolone. These observations support the concept of BP as a potential cutaneous marker of pathology of the digestive system. Patients with newly diagnosed widespread BP should undergo oncological screening with evaluation of the gastrointestinal tract and targeted assessment of the hepatobiliary system, and their management should be organized within a multidisciplinary framework.