Bullous Pemphigoid Complicated with Tuberculosis: Report of 4 Cases and Literature Review

  Objective  To explore the clinical and laboratory characteristics of bullous pemphigoid (BP) complicated with tuberculosis.

  Methods  The clinical data of 4 inpatients with BP complicated with tuberculosis, who were diagnosed and treated in Department of Dermatology, PUMC, from January 1990 to April 2012, were retrospectively analyzed, and meanwhile the relevant literature was reviewed.

  Results  Purified protein derivative (PPD) test showed negative results in three patients and positive in the remaining one patient. The level of eosinophils in all these 4 cases remarkably increased and was parallel with the severity of the disease. Three patients received rifampicin and prednisone combination therapy and the remaining one patient was treated with isoniazide, ethambutal, pyrazinamide, and corticosteroid. The dose of prednisone exceeded 180 mg/d in 2 patients. Clinical complete remission of bulla was achieved in 3 patients, and tuberculosis was also controlled. Intravenous immunoglobulin showed short-term efficacy in 2 patients.

  Conclusions  The potential tuberculosis infection should be carefully screened in BP patients who have received long-term steroid treatment. PPD often shows false negative results in these patients. If rifampicin and prednisone are used in combination, the dose of prednisone should be increased by at least two fold. Furthermore, intravenous immunoglobulin provides a good alternative treatment for BP with tuberculosis.