A 71-year-old female presented with scaly erythema all over the body for 30 years and blisters for 4 months.Scattered scaly erythema appeared on the whole body 30 years ago,and the patient was diagnosed as"psoriasis"in a another hospital,and the effect of traditional drug treatment was not good.Four months ago,the patient was given secukinumab injection treatment in a another hospital,and a large number of erythematous plaques,blisters,and maculopapular blisters appeared on the skin of the torso and the four limbs on the second day after the second injection.Histopathology:subepidermal blisters were formed,and neutrophils were seen in the blisters;the epidermis around the blisters was hyperkeratotic,focally hyperkeratotic,with a little nuclear dust,thinning of the granular layer,and thickening of the stratum spinosum;there was a little infiltration of lymphocytes and phagocytic pigment cells around the blood vessels in the superficial layer of the dermis;Direct Immunofluorescence(DIF)showed:C3-positive lineal deposition of the epidermal basement membrane.Indirect immunofluorescence(IIF):positive deposition of circulating antibody IgG on the epidermal side.Diagnosis:bullous pemphigoid,psoriasis vulgaris.Treatment:methylprednisolone 60mg/d combined with methotrexate 15 mg once per week.One month later,methylprednisolone was reduced to 24 mg/d,herpetic pemphigoid did not recur,and erythematous scales on trunk and limbs subsided.
维普
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