Rifampin-induced bullous pemphigoid in tuberculosis treatment: A strategic rechallenge approach

Abstract Purpose The purpose of this case report is to highlight an unusual presentation of rifampin-induced bullous pemphigoid in a 37-year-old female undergoing tuberculosis treatment. The report aims to explore the challenges of managing drug-induced bullous pemphigoid while maintaining effective treatment for tuberculosis, emphasizing the necessity of a strategic approach to drug management and disease control. Summary A 37-year-old female with tuberculosis developed an atypical form of bullous pemphigoid during rifampin therapy. The patient presented with painful, pruritic vesicular lesions that directly manifested as bullous lesions without the typical prodromal phase and without mucosal involvement. Histopathological examination confirmed the diagnosis with subepidermal blisters and eosinophilic infiltration. Management of this case involved carefully balancing tuberculosis treatment with bullous pemphigoid control, which required a modified rechallenge protocol, dose titration of rifampin, and a combination of systemic corticosteroids, immunomodulators, and supportive care. Conclusion This case underscores the complexity of managing drug-induced bullous pemphigoid in patients undergoing treatment for tuberculosis. The successful outcome was achieved through a cautious approach, including a rechallenge protocol and careful drug dose adjustments. The case offers valuable insights for clinicians managing similar complex presentations of drug-induced bullous pemphigoid, demonstrating that, with a tailored treatment strategy, both conditions can be effectively controlled.