P045 A rare case of pemphigus erythematosus following bilateral hip abscesses due to hyaluronic acid dermal filler injections

Abstract

A 22-year-old woman with skin type V presented with a 2-year history of widespread hyperpigmented rash. Prior to its onset, she had cosmetic crosslinked hyaluronic dermal filler injections into the hips bilaterally. This was complicated by bilateral hip abscesses requiring hospital admission for intravenous antibiotics (co-trimoxazole and metronidazole), incision and drainage, and interventional radiology-guided drain insertion. She had no background medical history and no known family history of autoimmunity. She described constant pruritus with intermittent small blisters, which she self-deflated leaving hyperpigmented scarring. Her face, chest, limbs and trunk were affected, with flares in summer months indicating a photosensitive nature. There was scalp involvement with associated patchy alopecia. There was no mucosal involvement, and she denied systemic features. Over this time, trialled treatments included tetracycline antibiotics, topical steroids and antifungals. Examination revealed one intact blister on the left thigh, multiple active erosions with predominant scalp involvement and widespread postinflammatory hyperpigmentation. Laboratory investigations were non­contributory, with full blood count, complement levels and antinuclear antibody within normal limits. Targeted skin biopsies were taken for clinicopathological correlation. Histology from the intact blister demonstrated a subcorneal–intraepidermal pustule with prominent acantholytic cells in the epidermis indicating an acantholytic dermatosis under haematoxylin and eosin staining. Direct immunofluorescence from perilesional skin was positive for intercellular IgG and C3, with granular deposition of C3 at the dermoepidermal junction. A diagnosis of pemphigus erythematosus was made and the desmoglein-1 antibody result is pending. Pemphigus erythematosus is a rare bullous disorder with features of pemphigus foliaceus and lupus erythematosus, first described by Senear and Usher in 1926. There have been rare documented cases of pemphigus following dermal filler therapies but to the best of our knowledge this is the first association with this pemphigus subtype. This case outlines the importance of clinicopathological correlation, particular in darker skin types.