Clinical Challenge Answer 6

This patient had Oesophageal involvement of bullous pemphigoid.

Congratulations to Dr Protima Amon for getting the correct answer.

Bullous pemphigoid (BP) is an acquired bullous disorder that is not often seen in children, but it can present with considerable clinical and histologic overlap with other acquired or congenital blistering disorders. This patient’s bullous pemphigoid was classified as type II because of the presence of antibodies against the 180-kDa basement membrane antigen. The patient was started on prednisolone, after consulting dermatology team, with rapid improvement of symptoms. The prednisone was tapered down and at follow-up and he did not have any gastrointestinal or skin problems.

Other diseases presenting with vesico-bullous or exfoliative esophagitis include herpes simplex virus, oesophagitis dissecans superficialis, graft-versus-host disease, reactions to blood transfusion, and amyloidosis- most often seen in adult patients, but can be seen in children as well.