Ischemic stroke and acute pemphigus – Two partners in crime

Abstract

Introduction. Bullous dermatoses are a group of skin-specific autoimmune diseases with systemic involvement that have a molecular basis related to the development of IgG autoantibodies targeted against desmosome proteins. The purpose of this report consists in marking the association between an acute cerebrovascular event and an active phase blistering dermatosis, at a patient with no other known risk factors. Case presentation. Female patient, 46 years old, diagnosed with pemphigus vulgaris one year before, was admitted to the emergency room with left hemiparesis. The general physical examination shows multiple fragile blisters with serocitrin content and well-defined painful skin erosion, localized on the limbs, thorax and abdomen. The neurological examination revealed a conscious, cooperative, right-handed patient with left proportional flaccid hemiparesis, and homonymous hemianopia. Native cranio-cerebral computed-tomography described acute infarction in the right sylvian arterial territory. Extensive paraclinical tests did not reveal an evident pathogenesis of acute ischemic stroke. Conclusions. Patients with bullous dermatosis have a two-folded increased risk of stroke, particularly ischemic stroke and this risk remains high even after controlling modifiable cardiovascular risk factors. The neurologist should consider implementing primary ischemic stroke prevention in patients diagnosed with bullous dermatosis.

Keywords

• stroke
• pemphigus vulgaris
• bullous dermatosis