Case Report
A 70-year old male patient was referred to our clinic with 3 month history of pruritic, non-healing ulceration on his face. The lesion showed no improvement from topical antibiotics prescribed in an outpatient setting. According to our patient, potent topical corticosteroid ointments led to temporary remission only.
Dermatological examination revealed 3x3 cm erythematous plaque with central ulceration on his infra-auricular area. (Fig. 1) There was no involvement of oral, nasopharyngeal, genitourinary and ocular mucosa.
Two 4 mm punch biopsies were obtained, one from edge of the ulcer and the other from perilesional skin. Histopathology revealed subepidermal splitting and diffuse lymphocytic infiltration in the papillary dermis. (Fig. 2) Direct immunoflourescence (DIF) analysis showed strong linear IgG and C3 positivity along the basement membrane.
According to these results, our patient was diagnosed with Brunsting-Perry pemphigoid. Intralesional rituximab was administered for treatment. Intravenous hydrocortisone and pheniramine maleate were given prior to the injections, as part of the premedication protocol. Four sessions of intralesional rituximab (10 mg/ml) injections were performed in total, each with a 2-week interval. 1 mg of rituximab (0.1 ml) was injected one centimeter apart until the entire lesion was covered. A noticable improvement was noted at the end of four sessions. (Fig. 3)