A RARE CASE OF BULLOUS PEMPHIGOID WITH SUBCORNEAL PUSTULAR DERMATOSIS AND SECONDARY CELLULITIS: A UNIQUE TRIAD

Madhu Andappa Lakkundi*, Dr. Ravi M. Rathod, Dr. Preeti V. Kulkarni and Dr. Venkatrao H. Kulkarni

ABSTRACT

A 68-year-old female with a long-standing history of Bullous Pemphigoid (BP) presented with widespread, painful pustular lesions and right lower limb swelling. Histopathology and immunofluorescence confirmed BP and Subcorneal Pustular Dermatosis (SPD) while clinical and USG Doppler findings indicated secondary cellulitis. The patient had hypersensitivity to Dapsone and Amoxyclav limiting therapeutic options. She was managed with systemic corticosteroids (Prednisolone), immunosuppressants (Cyclosporine, Cyclophosphamide) and broad-spectrum antibiotics (Ceftriaxone, later Meropenem) along with supportive care. Gradual clinical improvement was observed with resolution of lesions and post-inflammatory hyperpigmentation. This case represents a rare triad of BP, SPD and Secondary Cellulitis posing significant diagnostic and therapeutic challenges. It underscores the importance of early diagnosis, multidisciplinary care, and a carefully balanced treatment approach in managing complex autoimmune and infectious dermatological conditions.

Keywords: Bullous Pemphigoid (BP), Subcorneal Pustular Dermatosis (SPD), Secondary Cellulitis, Immunosuppressants, Broad-Spectrum Antibiotics, Histopathology and Immunofluorescence.