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Septic arthritis mimic — ABIM Board MCQ

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HardRheumatology/Allergy/ImmunologySeptic arthritis mimicABIM Board

An 82-year-old woman has intensely pruritic tense bullae confined to the trunk and proximal thighs. Biopsy with direct immunofluorescence confirms bullous pemphigoid. She has severe osteoporosis and brittle diabetes but can apply medication with caregiver help. What is the best initial treatment?

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Correct answer: A — Topical clobetasol applied to involved skin

The best answer is “Topical clobetasol applied to involved skin”. Limited bullous pemphigoid can be treated effectively with high-potency topical corticosteroids, avoiding much of the systemic toxicity that is particularly hazardous here. Systemic therapy is reserved for extensive or refractory disease. Doxycycline can be considered when corticosteroids are unsuitable but is not more effective for rapid blister control.

Reference: American Academy of Dermatology: Bullous Pemphigoid: https://www.aad.org/public/diseases/a-z/bullous-pemphigoid-treatment