Infantile Bullous Pemphigoid Following Vaccination
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Case Report
A 2-month-old girl presented to the dermatology outpatient department with complaint of fluid filled lesions over limbs, face, trunk, and groin area of 10 days duration. The lesions initially appeared over the chest region and extended to involve limbs, palms, soles, face, abdomen, oral and genital mucosae, and scalp over the next two days. There was no history of accompanying fever, diarrhea or prior drug intake, and the child was taking feeds normally. She received first dose of DPT and hepatitis B vaccines two days prior to onset of lesions. She was a product of full term normal vaginal delivery born of a non consanguineous marriage, and there was no history of similar complaints in the family members. Examination revealed multiple tense vesicles and bullae predominantly over extremities, palms, soles and face. There were multiple targetoid lesions over trunk and multiple erosions all over body including scalp, oral and genital mucosae. Tzanck smear showed few eosinophils without acantholytic cells and no organisms were seen on Grams staining. She had been started on intravenous vancomycin with a provisional diagnosis of bullous impetigo, with no response. All hematological investigations were unremarkable and blood culture was negative. A skin biopsy and direct immunofluorescence was performed with differential diagnoses of linear IgA dermatosis and infantile bullous pemphigoid. Histological examination revealed subepidermal bulla with dense eosinophilic infiltrate and DIF showed linear deposits of IgG and C3 and absence of IgA and IgM at dermo-epidermal junction.....