Co esponding au ho : H Ma ghadi
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Twice- igge ed localized bullous pemphigoid ollowing o hopedic su ge y: A a e
p esen a ion
Haja . Ma ghadi 1, 2, *, Kaou a . Elmachichi 1, 2, Ma yem. Aboudou ib 1, 2, Oua ae.Hoca 1, 2 and Said Amal 1, 2
1 Depa men o De ma ology, Uni e si y Hospi al Mohammed VI, Ma akech, Mo occo.
2 Biosciences and Heal h Labo a o y, Cadi Ayyad Uni e si y, Ma akech, Mo occo.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 1459-1461
Publica ion his o y: Recei ed on 26 Ma ch 2025; e ised on 06 May 2025; accep ed on 09 May 2025
A icle DOI: h ps://doi.o g/10.30574/wja .2025.26.2.1650
Abs ac
Localized bullous pemphigoid (BP) is a a e a ian o an au oimmune blis e ing disease commonly a ec ing elde ly
indi iduals. While BP is ypically associa ed wi h sys emic igge s, i s localized o m can esul om physical auma
o su gical p ocedu es. We p esen a case o a 60-yea -old man who de eloped localized BP ollowing wo o hopedic
su ge ies on he same limb. Two weeks a e emu ac u e ixa ion wi h e og ade in amedulla y nailing, he
de eloped ense, p u i ic bullae a ound he knee and lowe leg. His opa hological analysis and di ec
immuno luo escence con i med he diagnosis o BP. Lesions esol ed a e ea men wi h o al co icos e oids.
Howe e , he pa ien expe ienced a ecu ence o simila lesions a e a second p ocedu e o bone g a ing due o
ac u e non-union. The lesions ex ended abo e he knee bu esponded o he same co icos e oid egimen, esol ing
comple ely. This case highligh s he po en ial ole o su gical auma and pos ope a i e issue changes as igge s o
localized BP, emphasizing he impo ance o ea ly ecogni ion and managemen .
Keywo ds: Localized Bullous pemphigoide; o hopedic su ge y; BP180/BP230 au oan ibodies; au oimmune
blis e ing disease
1. In oduc ion
Bullous pemphigoid (BP) ypically a ec s elde ly indi iduals and is known o i s widesp ead, i chy, ense blis e s.
Howe e , localized bullous pemphigoid is a a e a ian and can be easily misdiagnosed due o i s limi ed p esen a ion.
This case epo desc ibes an unusual ecu ence o localized BP ollowing wo sepa a e o hopedic su ge ies in he
same pa ien , emphasizing he impo ance o ecognizing su gical auma as a po en ial igge .
2. Case P esen a ion
We epo he case o a 60-yea -old man who unde wen o hopedic su ge y o a igh emu ac u e, ea ed wi h
e og ade in amedulla y nailing. Two weeks pos -su ge y, he de eloped i chy, ense bullae localized a ound he igh
knee and lowe leg. His ological examina ion o a skin biopsy e ealed subepide mal blis e s wi h eosinophilic
in il a ion, and linea IgG and C3 deposi s along he basemen memb ane zone on di ec immuno luo escence. These
indings con i med he diagnosis o localized bullous pemphigoid.
The pa ien was s a ed on o al p ednisone (0.5 mg/kg/day), which led o comple e esolu ion o lesions wi hin h ee
mon hs. Howe e , due o a non-union o he ac u e, he la e unde wen a bone g a p ocedu e. Rema kably, jus days
a e he second su ge y, simila blis e s eappea ed, his ime ex ending a ound he igh high and knee. The same
co icos e oid egimen was esumed, esul ing in esolu ion wi hin wo mon hs.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 1459-1461
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3. Discussion
While bullous pemphigoid is well- ecognized, i s localized a ian is less common and o en associa ed wi h auma,
bu ns, pho o he apy, o adia ion. Pos -su gical BP is exceedingly a e, and ecu en episodes a e mul iple su ge ies
in he same ana omical egion a e e en mo e excep ional. I is hough ha issue damage in e e es wi h he humo al
media ed immuni y, causing al e a ion o BP180 and BP230 an igens
In his case, he ecu ence o BP a e wo sepa a e p ocedu es s ongly suppo s a link be ween su gical auma and
disease onse . Al hough koebne iza ion— he appea ance o skin lesions a si es o auma—has been p oposed as a
mechanism, we sugges ha localized edema ollowing su ge y may ha e ac ed as he immunological igge . This
hypo hesis is suppo ed by he dis ibu ion o blis e s beyond he immedia e su gical si e.
To ou knowledge, his is only he second epo ed case o ecu en localized BP igge ed by epea ed su gical
in e en ions in he same pa ien . De ma ologis s and su geons should be awa e o his possibili y o ensu e imely
diagnosis and ea men .
Figu e 1 Mul iple pos -bullous e osions on he lowe limb
4. Conclusion
This a e case illus a es how o hopedic su ge y may igge localized bullous pemphigoid, e en mo e unusually on
wo sepa a e occasions. I highligh s he impo ance o main aining clinical suspicion in pos ope a i e se ings,
pa icula ly in elde ly pa ien s p esen ing wi h localized blis e ing e up ions.
Compliance wi h e hical s anda ds
Disclosu e o con lic o in e es
No con lic o in e es o be disclosed.
S a emen o in o med consen
W i en in o med consen was ob ained om he pa ien o he publica ion o his case epo and accompanying
images.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 1459-1461
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Re e ences
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