Mucormycosis complicating bullous pemphigoid: A rare case report

Bullous pemphigoid is an autoimmune subepidermal blistering condition of the skin and mucous membranes primarily affecting the elderly and characterised by diffuse eczematous, pruritic, urticaria-like lesions with the later emergence of tense bullae or blistering lesions filled with clear fluid. These are diagnosed by clinical, histologic, and immunologic criteria and are often treated with corticosteroids which are known to have secondary infections, however, the occurrence of mucormycosis is infrequent. A 76-year-old female presented with a complaint of painful red and itchy fluid-filled lesions which were gradually progressive. She was diagnosed as a bullous pemphigoid and was treated with corticosteroids, antibiotics and topical ointments. Post Treatment a necrotic skin patch was noted on the right scapular region which was excised and showed multiple scattered broad non-branched aseptate fungal hyphae on microscopic examination which on PAS and GMS stain confirmed mucormycosis. Though the incidence of secondary infections is sometimes seen in a corticosteroids-treated patient of bullous pemphigoid, however, rare differentials like mucormycosis should be considered for a timely diagnosis and immediate treatment to prevent mortality and morbidity.