Bullous dermatosis in an older adult

Abstract

A 72-year-old male with a history of high blood pressure, severe alcoholism, smoking, intermittent use of ibuprofen, and chronic cognitive impairment consulted for a 45-day history of generalized bullous dermatosis.

Physical examination revealed painful erosions with a reddish background in the oral cavity and on the hard palate, and tense blisters on the face, trunk, and extremities, some with serous content and others with blood, mostly on healthy skin. These lesions alternated with erosions and extensive areas of denuded skin, in sectors surrounded by an epidermal collarette. It is worth highlighting the significant acral involvement that he presented. The Nikolsky sign was positive.

The following complementary tests were performed: 1) laboratory: albumin 2.6, total proteins 5.3, the rest without particularities; 2) tumor markers: alpha-fetoprotein, carcinoembryonic antigen, total PSA, and B2 microglobulin negative; 3) Skin histopathology: dermoepidermal blister with predominantly neutrophilic inflammatory infiltrate; 4) Direct immunofluorescence (DIF): linear deposit of IgA and C3 in the dermoepidermal junction area; 5) IIF in rat bladder: negative.