D2.479 - The bullous pemphigoid in a baby

Introduction. Bullous pemphigoid is a rare autoimmune disease. The estimated incidence in children is approximately 0.2-0.5 cases per million children per year. It is characterized by the formation of fluid-filled blisters and is often accompanied by itching. The clinical course and localization of the rash in infants and older children differ, but the involvement of the palms and feet in both age groups is common. The etiology is currently unknown, but there is evidence that such an atypical immune response may be caused by nonspecific maternal antibodies and foreign antigens.

 Clinical case. Described in a four-month-old child. The child was born full-term, vaccinated according to age. Hereditary history is not burdened. There were no allergies in the family.

The rash was characterized by multiple blisters on the palms, soles, and fingers, and numerous papular elements on the trunk. According to the mother, the child fell ill a month ago, when a rash appeared in the oral cavity on the palate. Then, multiple blisters began to appear on the feet and palms. There was a temporary improvement after 3 days of systemic corticosteroids, but new elements of the rash appeared a few days later. According to laboratory blood tests: eosinophils were 5.6*10⁹/L Biochemical blood tests and general urine analysisdid not reveal any abnormalities.  After diagnostic biopsy and direct immunofluorescence, the diagnosis of bullous pemphigoid was confirmed. The boy was prescribed prednisolone at a dose of 1 mg/kg per day for 3 months with a gradual dose reduction. 1 year passed after the drug was discontinued. No relapses were observed.

Conclusions. Bullous pemphigoid is not a common disease among children. However, incorrect tactics in diagnosis and treatment can lead to serious consequences.