Objective:

To describe a case of severe bullous pemphigoid developing after leuprolide acetate administration in a patient with multiple sclerosis.

Approach:

• Case: A 52-year-old woman with untreated multiple sclerosis developed generalized pruritus and, about 1 week after a single depot leuprolide injection for uterine fibroids, a progressive blistering eruption.
• Diagnosis: Skin biopsy confirmed bullous pemphigoid, showing eosinophilic inflammation at the dermal–epidermal junction and IgG and C3 deposition on direct immunofluorescence.
• Treatment: The disease progressed despite topical corticosteroids, prednisone escalated to 80 mg daily, and mycophenolate mofetil, which provided limited clinical benefit. Dupilumab was subsequently administered.

Key Findings:

• Over 6–7 weeks, the eruption progressed to involve more than 50% of body surface area; oral mucosal involvement was absent.
• After dupilumab treatment, new blister formation ceased and gradual clinical improvement was reported.
• The authors describe established associations between bullous pemphigoid and neurologic diseases, including multiple sclerosis, and note that reports of leuprolide-associated bullous pemphigoid are rare.

Interpretation:

The authors identify leuprolide acetate as a potential trigger of bullous pemphigoid in a patient with multiple sclerosis; this case report does not establish causation.

Limitations:

• This is a single case, so it cannot establish that leuprolide caused the disease or determine how often this reaction occurs.
• The supplied context does not include the remainder of the discussion or detailed follow-up outcomes.

Conclusion:

The authors report severe bullous pemphigoid developing about 1 week after leuprolide acetate administration in a patient with multiple sclerosis. New blister formation ceased and gradual clinical improvement was reported after dupilumab treatment.

Sources:

• Article context supplied in the prompt