Bullous Pemphigoid and Cognitive Impairment in Elderly Patients: A Case Report of Two Patients Highlighting the Possible Link with Neurodegeneration

Abstract

Background

Bullous pemphigoid (BP) is an autoimmune blistering disorder, predominantly affecting elderly patients, often in conjunction with neurodegenerative diseases such as dementia. Emerging research suggests a complex and bidirectional relationship between BP and cognitive decline, highlighting the need for deeper exploration into their shared pathophysiology.

Case Report

1. Female, 78 years old, diagnosed with Lewy body dementia, presented with pruritic erythematous-bullous lesions that began on the limbs and later spread to the trunk. Diagnostic tests confirmed BP180-type BP. Treatment with topical steroids and systemic methylprednisolone led to significant improvement, though a flare-up occurred when steroid dosage was reduced.

2. Male, 81 years old, diagnosed with mild neurocognitive disorder and Meniere’s syndrome, developed pruritic bullous lesions on both lower limbs, accompanied by fever. Diagnostic process confirmed BP180-BP230-type BP. His condition improved rapidly with betamethasone and methylprednisolone, with no flare-ups upon treatment completion.

Conclusion

These cases highlight the complex relationship between BP and neurodegenerative diseases in elderly growing population. The
mechanisms remain unclear, but potential factors include shared risk factors, autoantibody cross-reactivity, and BP as a marker of neurodegeneration. Preliminary evidence suggests that cognitive impairment may influence BP's clinical presentation, with different autoantibodies patterns linked to dementia severity. Continued research is crucial to elucidate these links.