Pustaka Ilmiah Universitas Padjadjaran

Abstrak

Childhood Bullous Pemphigoid Treated With Corticosteroid Sparing-therapy With Azathioprine In An 18-year-old Girl: A Case Report

Background Bullous Pemphigoid (BP) is rarely found in childhood. It is established based on BP diagnostic criteria with patient’s age up to 18 years old. Combination therapy (steroid sparing-therapy) can be used to minimize steroid side effect. Azathioprine was chosen because of its rapid action, therefore complete remission can be obtained quickly. Case An 18-year-old girl was admitted to Dermatovenereology Department, Dr. Hasan Sadikin Hospital Bandung, with chief complaints of blisters and itchy erythematous macules distributed widely on almost her entire body, except the scalp, lower legs, and feet. History taking, physical examination, routine laboratory analysis, histopathology examination, and direct immunofluorescence were done to conclude the diagnosis. Discussion The lesions were erythematous macules, plaques, and tense blisters that initially occured on both arms, then spread to almost her entire body. On observation, the blisters tended to spread on the oral mucous membrane. Histopathological examination revealed subepidermal vesicobullous reaction with minimal erythrocyte, lymphocyte, and eosinophil. Direct immunofluorescence revealed immunoglobulin G deposit at the dermoepidermal junction. The patient was given intravenous dexamethasone, which then replaced with methylprednisolone equals to 1 mg/kgBW/day prednisone when she was discharged from the hospital. Sparing-therapy given on day 13th was 50 mg azathioprine, twice daily, orally. Improvement was seen at the 10th days of sparing-therapy administration.