Clinical case of the sepsis development in a patient with bullous pemphigoid

Abstract

Patients with rare diseases, particularly skin conditions, can be particularly problematic for doctors of intensive care units. The present study shows the features of the course of sepsis in bullous pemphigoid in terms of clinical case management. A 66-year-old patient with polymorbid pathology was admitted for scheduled hospitalization to the Endocrinology Department with a diagnosis of non-insulin-dependent diabetes mellitus with multiple complications, and examined. She complained of pain in the small of the back and abdomen irradiating to the inguinal region, and increased oedema of the lower extremities. A few hours after admission to the Endocrinology Department, she was transferred to the intensive care unit due to the deterioration of her condition. Analysis of the severity and prognosis assessment of her condition was performed: 9 scores according to SOFA, 20 scores according to APACHE II. The patient underwent clinical, laboratory (biochemical, immunological, bacteriological, cancer markers, blood gases), instrumental methods of examination (Doppler ultrasonography of the lower extremity veins, brain MRI, chest MRI, lumbar puncture). A skin biopsy for morphological study was taken. The analysis of test results showed a critical condition of the patient with a high risk of death, which was prognostically dangerous. Bullous pemphigoid diagnosis was established by morphological and immunological assays. The patient was prescribed therapy with due account for her polymorbidities: prednisolone 80 mg orally, antibiotic therapy, later on she was transferred to the mechanical ventilation. A session of substitutive renal therapy CVVHD using the Prismaflex system was performed. After treatment, improvement was observed. Over the 3-month follow-up care, the patient's condition has been stabilised. It is critical for doctors of various specialties to identify signs of bullous pemphigoid in a timely manner, assess the risk of developing sepsis and take appropriate therapeutic measures in case of secondary infection, as the polymorbidity of pathological conditions can lead to death.