Drug-Aggravated Bullous Pemphigoid in a 47-year-old Asian Woman - A Case Report.

INTRODUCTION: Bullous pemphigoid is the most common chronic recurrent autoimmune subepidermal blistering disorder most prevalent in geriatric population. It varies widely in clinical presentation ranging from tense bullae to intense generalized pruritus. It is immunologic in origin with the presence of IgG antibodies. CASE REPORT: A 47-year-old female presented to the hospital with complaints of blisters in the lower limbs, which she was self managed with neem oil after which the blisters occurred over the body. The patient also experienced blisters over both upper and lower limbs, gluteal region, painful generalized uclers, necrotic patches, multiple erythematous blisters, ulcer erosions over bilateral legs and upper limbs with few lesions, which were foul-smelling and oozing. On second day of admission, the patient's CRP and ESR levels were tested and the levels were 33.5 and 35mm/hr respectively. The patient was treated with injection meropenem 1 g three times daily, injection dexamethasone 4 mg once daily and injection ofloxacin 400 mg once daily. On the third day of admission, the patient complained of leg swelling and subsequently D-Dimer levels were checked which showed a value of 5,740 and was treated with injection enoxaparin 40 mg for same throughout the course of hospital stay A skin biopsy confirmed the diagnosis of bullous pemphigoid.. The culture test showed the growth of Klebsiella pneumonia and Acinetobacter baumani, which were resistant to most of the antibiotics. The patient was managed appropriately with modalities including antibiotics, anti-inflammatory agents, immunosuppressants, multivitamins, fluids, and albumin. The patient responded well to the treatment without new lesions or fever spikes. There was presence of necrotic patches of old lesions alone at the time of discharge. CONCLUSION: This case report was done with the purpose of presenting an exemplary case of bullous pemphigoid aggravated by the application of neem oil and emphasizing the inappropriate use of folk medicine in an autoimmune disease like bullous pemphigoid.