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February 2013

Worsening of Bullous Pemphigoid Following Bacillus Calmette-Guérin Treatment for Bladder Cancer

Author Affiliations

Author Affiliations: Departments of Dermatology (Ms Johnson and Drs West and Travers), Pharmacology and Toxicology (Dr Travers), and Pediatrics & H. B. Wells Center for Pediatric Research (Dr Travers), and Richard L. Roudebush VA Medical Center (Dr Travers), Indiana University School of Medicine, Indianapolis.

JAMA Dermatol. 2013;149(2):248-249. doi:10.1001/2013.jamadermatol.729

Bullous pemphigoid is an autoimmune disease characterized by subepidermal bullae that can involve nearly any skin surface and primarily affects the elderly. Only in a minority of cases are there known precipitating factors, some of which include vaccinations.1

Report of a Case.  An 86-year-old white man with a 5-year history of bullous pemphigoid presented with a flare of disease activity. Until this flare, his disease had been well controlled for approximately 1 year, and he was blister free under treatment with mycophenolate mofetil, 500 mg/d, prednisone, 5 mg/d, and doxycycline, 100 mg/d. He was recently diagnosed as having bladder cancer and began intravesical bacillus Calmette-Guérin (BCG) treatments. New blister development began approximately 1 week after initiating therapy. By the end of the second week, he was experiencing a significant flare and declined further BCG treatment. His prednisone dose was increased to 20 mg/d, and his symptoms rapidly improved by his clinic visit.