[A case of bullous pemphigoid associated with Pneumocystis pneumonia and Cytomegalovirus pneumonia].

A 68-year-old man was admitted to our hospital presenting cutaneous pruritic lesions consisting of tense blisters with serous content on his arms and legs. Histological findings of skin biopsy confirmed a diagnosis of bullous pemphigoid in March 2005. After 10 weeks of prednisone therapy for bullous pemphigoid, he presented with increasing breathlessness and high fever. He was admitted to our hospital because of severe hypoxemia on May 29, 2005, and mechanical ventilation was started from the first hospital day. Chest computed tomography showed marked ground-glass opacities in both lungs. The levels of beta-D glucan and KL-6 in his sera were elevated. We suspected Pneumocystis pneumonia and Cytomegalovirus pneumonia. Under mechanical ventilation, he received steroid pulse therapy, and sulfamethoxazole-trimethoprim and ganciclovir. A polymerase chain reaction assay of bronchoalveolar lavage fluid showed Pneumocysitis DNA and Cytomegalovirus DNA. On the 12th hospital day, he was weaned from mechanical ventilation. Follow-up chest computed tomography showed marked resolution of diffuse ground-glass opacity in both lungs. We need to consider the development of Pneumocystis pneumonia and Cytomegalovirus pneumonia during steroid therapy for bullous pemphigoid.