Successful induction treatment of bullous pemphigoid using reslizumab: a case report

Abstract

Background Bullous pemphigoid (BP) is a potentially life-threatening autoimmune blistering disease which is characterized by autoantibodies against hemidesmosomal proteins of the skin and mucous membranes. In recent years, the role of eosinophil and immunoglobulin E autoantibodies have been further elucidated in BP, and have been considered potential therapeutic targets. Case presentations A 67-year-old male presented with erythematous bullous eruption. The skin eruption was located on whole body, and suggested BP. Peripheral blood eosinophil count and total immunoglobulin E markedly elevated in initial laboratory findings. Topical and systemic steroid (methylprednisolone 2 mg/kg/day) treatment was started, and his skin symptoms worsened repeatedly, whenever systemic steroid were reduced. On admission day 29, reslizumab (anti-interleukin-5) 3.5 mg/kg was administered intravenously to the patients. The bullous skin lesion began to improve rapidly, and methylprednisolone (8 mg/day) was reduced without any worsening of symptoms during two doses of reslizumab. Conclusions We report a case of successful treatment response to reslizumab administration in a patient with BP. Further studies are needed to confirm the role of anti-interleukin-5 as a treatment for BP in the future.

Bullous Pemphigoid: A Spontaneous Presentation in a Patient With Chronic Kidney Disease

“…Eosinophilic tissue infiltration serves as functional antigen-presenting cells with direct cleavage of BP180. This distinguishes BP when compared to anti-Dsg1 and anti-Dsg3 antibodies present in PV [ 10 - 14 ]. Ultimately, the gold standard for diagnosis of BP is direct immunofluorescence of a skin biopsy from the perilesional tissue with characteristic linear IgG and C3 deposits along the basement membrane [ 15 ].…”

“…Omalizumab has shown exciting potential with a recent study finding complete response rates as high as 80% and a mean recurrence time of 3.4 months. These biologics with mechanisms of action including inhibition of CD-20 proteins on B-lymphocytes, downregulation of IgE cell surface receptors on eosinophils, and IL-5 inhibition have shown great potential for future research into steroid-sparing treatments of BP [ 14 , 19 ].…”

A Case of Bullous Pemphigoid - Potentially Fatal Condition

“…The effects on patients with bullous pemphigoid, however, remain unclear. [11] Several studies have recommended and the use of steroidsparing medicines and plasma exchanges, although more evidence is needed before their use can be considered as routine.…”

Bullous pemphigoid—What do we know about the most recent therapies?

“…A small sample size and short follow-up duration were the major limitations in this pilot study. Conversely, a recent case report describes the rapid clinical regression of bullous skin lesions in a patient with BP upon treatment with reslizumab, another anti-IL-5 antibody, allowing tapering of systemic steroid dosage ( 68 ). In addition, re-exacerbation of skin lesions were noted upon discontinuation of reslizumab, despite use of maintenance cyclosporin ( 68 ).…”

“…Conversely, a recent case report describes the rapid clinical regression of bullous skin lesions in a patient with BP upon treatment with reslizumab, another anti-IL-5 antibody, allowing tapering of systemic steroid dosage ( 68 ). In addition, re-exacerbation of skin lesions were noted upon discontinuation of reslizumab, despite use of maintenance cyclosporin ( 68 ). Benralizumab is a humanized monoclonal antibody against IL-5Rα, which has been shown to cause direct apoptosis of eosinophils ( 69 , 70 ).…”