Coexistence Of Bullous Pemphigoid and Hyperthyroidism: A Case Report

R; olf A. Perez; Cecilia Ongjoco

doi:10.21767/2471-8041-C1-003

Coexistence Of Bullous Pemphigoid & Hyperthyroidism: A Case Report

8^th Edition of International Conference on Clinical and Medical Case Reports
May 28-29, 2018 London, UK

Randolf A. Perez and Cecilia Ongjoco

World Citi Medical Center, Philippines

Posters & Accepted Abstracts: Med Case Rep

DOI: 10.21767/2471-8041-C1-003

Abstract

Bullous pemphigoid (BP) is one of the most common autoimmune bullous diseases, although its frequency is less than pemphigus vulgaris (0.0004/100,000 vs 0.1-0.5/100,000 population [1]. In recent prospective studies from Germany and Switzerland, the annual incidence was about 12 to 13 new cases per 1 million population [2, 3]. It is primarily a disease of the elderly with an incidence among patients aged over 90 years being 40 per 100 000 population per year. The association of bullous pemphigoid with many other diseases has been mentioned before, but no common etio-pathogenic pathway has been demonstrated [4 5, 6]. The most frequent associations are those with primary biliary cirrhosis, psoriasis - 63.4%), and an unusual condition termed multiple autoimmune syndrome (MAS), defined as the combination of at least three autoimmune diseases in the same patient . With multiple autoimmune syndrome, we observe a special frequency of various dermatological autoimmune diseases, such as vitiligo, bullous pemphigoid, and pemphigus vulgaris. We conclude that there exists an association of Bullous pemphigoid & Thyroid disease in our case being both autoimmune mediated. Based on Humbert and Dupond classification, they belong to two different types of class of Multiple Autoimmune syndrome (MAS). Although not typical of MAS, a common pathophysiologic mechanism can explain their co-existence. Both Autoimmune thyroid disease (AITD) and Bullous pemphigoid (BP) have autoantibodies belonging to IgG class. Importantly, patients with AITD are known to express HLA-B8 and the risk of its development is increased in patients with haplotypes HLA-DR3 or HLA-DQA 1*501 & HLA-DR4 while BP patients usually show HLA-DQB1, an HLA possibly associated with multiple diseases of the APS group.