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Localised bullous pemphigoid overlying knee arthroplasty: a diagnostic challenge
  1. Adam Truss,
  2. Stylianos Papalexandris,
  3. Susan Gardner and
  4. Robert Harvey
  1. Department of Surgery, Arrowe Park Hospital, Wirral, UK
  1. Correspondence to Dr Adam Truss, aptruss{at}


An elderly Caucasian woman developed bullous pemphigoid (BP) overlying the site of total knee arthroplasty for osteoarthritis 2 days after surgery. The clinical findings were consistent with blistering due to soft tissue swelling, bullous impetigo or allergic contact dermatitis. The blistering spread over weeks to months down the ipsilateral leg and then to the other leg and hips. A biopsy for H&E and direct immunofluorescence established the diagnosis of BP. A concomitantly occurring wound infection was identified and treated. The blistering responded well to superpotent topical steroids and local care.

  • orthopaedics
  • joint interposition
  • dermatology

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  • Contributors The manuscript was primarily written by AT, the junior doctor looking after the patient, with contribution and editing by SP, the responsible specialist registrar. SG is a specialist orthopaedic nurse practitioner who has been involved in the management of the case presented and been a source of details surrounding the management. RH is the orthopaedic consultant for the patient and has supported the writing of this case report.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.