Psoriasis vulgaris, bullous pemphigoid, metabolic syndrome - Coincidence or common pathogenetic background? Case report

Abstract

Introduction. The correlation between psoriasis and metabolic syndrome has been well established. Psoriasis may also coexist with autoimmune blistering disease, mainly bullous pemphigoid. The pathogenetic relationship between psoriasis and pemphigoid remains unclear. It is highly likely that IL-17 might be a common factor underlying the coexistence of pemphigoid with psoriasis and metabolic syndrome. Objective. Presentation of a patient with coexisting psoriasis vulgaris, bullous pemphigoid and metabolic syndrome. Case report. We present a 35-year-old man with enormous obesity and suffering from psoriasis from the age of 20 who developed tense blisters with annular arrangement localized mainly on the trunk, the proximal part of extremities and oral mucous membrane. On the basis of direct immunofluorescence study of skin biopsy and BIOCHIP study the diagnosis of pemphigoid was established. Moreover, the patient's physical examination and the detailed analysis of laboratory tests led to the diagnosis of metabolic syndrome. Conclusions. To our knowledge, it is the first report demonstrating the development of psoriasis and pemphigoid in a patient with metabolic syndrome. Although the nature of this unique coincidence is not clear at the moment, methotrexate seems to be the first-line regimen for such cases.