Bullous pemphigoid induced by metamizole in a pediatric pati
The present case has been published in the Indian Journal of Dermatology. Bullous pemphigoid (BP) is a subepidermal autoimmune bullous dermatosis characterized by linear deposition of immunoglobulin G (IgG) and C3 along the dermoepidermal junction.

A previously healthy 14-year-old boy presented to our clinic with the complaints of bullous lesions in the face, scalp, neck, upper chest, and back. The patient noticed the lesions 24 h after receiving intramuscular metamizole due to the complaint of headache.

Skin examination revealed multiple tense bullae in the face, scalp, neck, upper chest, back, and genital region. In addition, numerous targetoid lesions were also present on the back. No lesion was detected in the oral mucosa. Routine laboratory workup including complete blood count and liver function tests was normal.

Histopathologic evaluation of the lesion site indicated subepidermal disintegration and lymphocyte infiltration accompanied by eosinophils in the upper dermis. Direct immunofluorescence (DIF) test of the perilesional area revealed a linear deposition of IgG and C3 in the basal membrane.

The patient was diagnosed as having pediatric BP depending on the clinical, histopathologic, and immunofluorescence findings. The patient was initiated on oral methylprednisolone (1 mg/kg/day) and all the lesions resolved within the first 3 days. At week 1, the methylprednisolone treatment was gradually terminated. No recurrence occurred within the 10-month follow-up.

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