Haddad GC, El Dada A, Sbeih S, Kazzi T, Karam K, Chaptini LA. Ulcerative colitis and bullous pemphigoid: Direct association or a medication side effect: A case report. World J Clin Cases 2025; 13(9): 101363 [DOI: 10.12998/wjcc.v13.i9.101363]
Corresponding Author of This Article
Louis A Chaptini, MD, Assistant Professor, Department of Medicine, Digestive Diseases, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06510, United States. louis.chaptini@yale.edu
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Mar 26, 2025; 13(9): 101363 Published online Mar 26, 2025. doi: 10.12998/wjcc.v13.i9.101363
Ulcerative colitis and bullous pemphigoid: Direct association or a medication side effect: A case report
Gaelle-Christie Haddad, Anthony El Dada, Sergio Sbeih, Tony Kazzi, Karam Karam, Louis A Chaptini
Gaelle-Christie Haddad, Anthony El Dada, Sergio Sbeih, Tony Kazzi, Department of Internal Medicine, University of Balamand, Beirut 100, Lebanon
Karam Karam, Louis A Chaptini, Department of Medicine, Gastroenterology, University of Balamand, Balamand 100, Lebanon
Louis A Chaptini, Department of Medicine, Digestive Diseases, Yale School of Medicine, New Haven, CT 06510, United States
Co-first authors: Gaelle-Christie Haddad and Anthony El Dada.
Author contributions: Haddad GC, El Dada A, Sbeih S, Kazzi T, Karam K wrote the first draft and contributed to manuscript conceptualization, data curation, and investigation; Chaptini LA edited the first draft and supervised the work and he is the manuscript guarantor.
Informed consent statement: Written informed consent was obtained from the patients to publish this report in accordance with the journal’s patient consent policy.
Conflict-of-interest statement: No author states to have any conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Louis A Chaptini, MD, Assistant Professor, Department of Medicine, Digestive Diseases, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06510, United States. louis.chaptini@yale.edu
Received: September 11, 2024 Revised: October 27, 2024 Accepted: November 19, 2024 Published online: March 26, 2025 Processing time: 91 Days and 11.3 Hours
Abstract
BACKGROUND
Bullous pemphigoid (BP) is an autoimmune blistering skin disorder. It is associated with other autoimmune disorders and the use of certain drugs. We describe a case of BP in a patient with ulcerative colitis (UC) treated with mesalamine.
CASE SUMMARY
A 38-year-old male patient with UC and a history of multiple flares was maintained on mesalamine with good clinical response. One year after starting mesalamine, he sought medical care following the onset of a severe itchy rash of several weeks’ duration with a recent appearance of skin bullae. A biopsy of the skin revealed subepidermal blistering dermatitis with focal eosinophilic spongiosis. Direct immunofluorescence studies revealed linear IgG and C3 immune reactant deposits at the dermoepidermal junction, consistent with the diagnosis of BP. Prednisone therapy alleviated his symptoms. However, tapering prednisone led to re-eruption of the bullae.
CONCLUSION
BP should be considered when patients with UC develop skin manifestations. Although BP is not one of the extraintestinal manifestations of UC, there may be an association between these two conditions. Whether treatment with mesalamine or other therapeutic agents plays a role in the development of BP remains unclear.
Core Tip: Physicians should be aware of the possibility that bullous pemphigoid (BP) could develop in patients with ulcerative colitis (UC). Although it is not listed as a known extraintestinal manifestation in UC, BP should be kept on the differential diagnosis list when patients with UC develop a skin condition. Whether BP is associated with UC or its treatment remains unclear. The fact that different agents have been incriminated in several reports makes the possibility of an association with the disease itself, rather than its treatment, more plausible.
