Full Text:

 

영남의대학술지 Vol.24_No.2 Suppl. P.S671-675, Dec. 2007

Case Report

상부 위장관 출혈로 발현된 식도의 수포성 유천포창 1 예

A Case of Esophageal Bullous Pemphigoid Manifestated by Upper Gastrointestinal Bleeding

김경옥, 장병익, 김태년, 은종렬
영남대학교 의과대학 내과학교실
책임저자:장병익, 대구광역시 남구 대명동 317번지, 영남대학교 의과대학 소화기내과학교실
Tel: (053) 620-3830, Fax: (053) 654-8386
E-mail: jbi@med.yu.ac.kr

December 30, 2007

Abstract

Bullous pemphiogid (BP) is a chronic vesicular disorder and an autoimmune disease which has an autoantibodies to hemidesmosime in the keratinocyte. The authors report a case of gastrointestinal bleeding caused by BP involved with esophagus. A seventy year old man visited our clinic due to melena for a week. He had a quadriplegia due to fracture of cervical spine and was on therapy with corticosteroid and immunomodulatory drug for the diagnosis of BP. On endoscopic examination, multiple bullae filled with blood at lower esophagus was revealed and there was no other bleeding focus in stomach and duodenum. Medical treatment for BP with supportive care was done. The patient died due to sepsis caused by pneumonia. BP is common in elderly or poor conditioned patients. We need to consider the invasion of esophagus in case of gastrointestinal bleeding in patients with BP.

Key Words: Bullous pemphioid, Upper gastrointestinal bleeding

References

1. Stanley JR. Cell adhesion molecules as targets of autoantibodies in pemphigus and pemphigoid, bullous diseases due to defective epidermal cell adhesion. Adv Immunol 1993;53:291-325.

2. Lopez JP, Bermejo FA. Treatment of pemphigus and pemphigoid. Med Oral Pathol CirBucal 2005 Nov-Dec;10:410-11.

3. Stanley JR. Bullous pemphigoid. In: Freedberg IM, Elsen AZ, Wolff K, et al, eds. Dermatology in general medicine. 5th ed. New York, NY: McGraw-Hill; 1999. p.666-73.

4. Yeh SW, Ahmed B, Sami N, Razzaque Ahmed A. Blistering disorders: diagnosis and treatment. Dermatol Ther 2003 Sep;16(3):214-23.

5. Chong VH, Lim CC and Vu C. A rare cause of acute upper gastrointestinal bleeding. Surg Laparosc Endosc Percutan Tech 2006 Apr;16 (2):91-3.

6. Jordon RE, Beutner EH, Witebsky E, Blumental G, Hale WL. Lever W.. Basement zone antibodies in bullous pemphigoid. JAMA 1967 May;200(9):751-56.

7. Yancey K, Egan C. Pemphigoid: clinical, histologic, immunopathologic, and therapeutic considerations. JAMA 2000 July;284(3): 350-56.

8. Yamada T, Alpers DH, Laine L, Owyang C, Powell DW. Textbook of gastroenterology. 3rd ed. Philadelphia: Lippincott Williams and Wilkins, 1999.

9. Nagashima R, Tsuge K, Harada M, Katagiri Y, Shinzawa H, Takahashi T. Endoscopic hemostasis of hemorrhage from esophageal bullous pemphigoid. Gastrointest Endosc 2000 Sep;52(3):433-4.

10. Yancey KB, Lawley TJ. Immunologically mediated skin disease. In: Fauci AS, Braunwald E, Isselbacher KJ, et al. Eds. Harrison’s Principles ofInternal medicine. 14th ed. New York, NY: McGraw-Hill; 1998. p. 1869-74.

11. Yancey KB. Cicatricial pemphigoid. In: freedberg Im, Eisen AZ, Wolff K, et al, eds. Dermatology in General Medicine. 5th ed. New York, NY: McGraw-Hill; 1999. p.674-9.

12. Hwang JY, Park KS, Cho KB, Hwang JS, Ahn SH. Esophageal mucosal desquamation with hemorrhage in bullous pemphigoid; a case report. Korean J Gastroenterol 2004 Apr; 43(4):264-7.