[Infantile bullous pemphigoid]

Abstract

Background: Bullous pemphigoid (BP) is a form of autoimmune bullous disease commonly seen in adults but rare amongst children. Only a few cases have been described in children after vaccination. This article reports a new case of BP that occurred in an infant after a first vaccination.

Patients and methods: A 3-month-old girl presented a bullous eruption 2 weeks after a first injection of Infanrix Quinta(®) and Prevenar(®). The eruption began on her palms and soles. It was associated with urticaria-like lesions on her thighs, chest and abdomen. A histological skin examination and direct immunofluorescence showed dermal-epidermal cleavage and IgG and C3 deposits in the epidermal basement membrane zone, which are typical features of BP. No antibodies against basement membrane were seen. Clinical remission was observed after 5 weeks of treatment with dermal-corticosteroids. Resumption of the vaccination schedule did not induce any recurrence of the disease.

Discussion: The clinical presentation of BP amongst children differs from that seen in adults, notably in terms of the predominance of palmoplantar lesions in children aged less than 1 year. In addition, lesions on mucous membrane are more frequently reported amongst older children. Histological findings are similar in all age groups. The outbreak of BP due to a vaccinal antigen appears hypothetical. However, continuation of the vaccination schedule did not induce any recurrence. Moreover, it is a rare disease amongst children despite the frequency of vaccinations in this population.

Conclusion: Childhood BP is a diagnosis that should be considered in any case of bullous eruption, in particular if the palms and soles are affected. It is a benign disease that resolves in less than a year under treatment. The current data do not incriminate vaccines in the outbreak of childhood BP and suggest that continuation of vaccination is not contraindicated.