Bullous Pemphigoid Associated With Acute Renal Allograft Rejection

摘要

Bullous pemphigoid (BP) can occur rarely with renal allograft rejection. Three cases have been reported in the literature, and all of them occurred during chronic rejection of transplanted kidneys. We report a case of acute renal allograft rejection presenting with bullous pemphigoid. A 46-year-old man was admitted to our hospital for a generalized bullous skin eruption. This was associated with mild decrease in urine output. He denied any history of pruritus, eye lesions, and photosensitivity. His other significant medical history included hypertension, hepatitis-C, and type-1 diabetes mellitus with end-stage renal disease. He received a cadaveric renal transplant in 2002. He was on tacrolimus and myco-phenolate mofetil, the later medication was discontinued a few weeks before onset of his symptoms. He denied taking any other medication. Physical examination revealed an oral temperature of 99.6 and a heart rate of 106. Cutaneous examination revealed widespread tense bullae over his face, trunk, and all four extremities. The remainder of the systemic examination was normal. At admission, serum creatinine was 2.4 with a blood urea nitrogen of 40 mg/dL. His baseline creatinine had been 1.0 mg/dL. Urinalysis revealed proteinuria without any evidence of infection. He had no eosi-nophiluria. Complete blood count, liver function test, chest X-ray, electrocardiog-raphy, renal ultrasound, polymerase chain reaction for cytomegalovirus, herpes simplex virus, and Epstein-Barr virus, 24-hour total urinary protoporphyrins, Wood's lamp screen for protoporphyria, and cultures of blister fluid were all normal.