# Exploring Environmental Triggers and Viral Associations in a Case of Severe Bullous Pemphigoid

## TL;DR

This paper presents a severe bullous pemphigoid case that may be linked to indoor pollutants and viral infections, emphasizing the disease's complex management.

## Contribution

The paper introduces a new potential environmental and viral association in bullous pemphigoid pathogenesis.

## Key findings

- The patient's severe BP did not respond to standard therapy.
- Indoor pollutants and viral infection are suspected triggers in this case.
- The case highlights the complexity of managing severe autoimmune blistering diseases.

## Abstract

Bullous pemphigoid (BP) is an autoimmune disease characterized by pruritic blisters and plaques, primarily affecting elderly individuals. The etiology of BP is multifactorial, with several documented triggers, the extent of which is currently unknown. This case reviews currently documented BP triggers and presents a case of severe and refractory BP, whose onset and progression raise suspicion for indoor pollutants and viral infection as inciting triggers. Our patient's condition worsened despite standard therapy, highlighting the complexity of BP management. This case adds to the literature, teasing out BP pathogenesis and highlighting the complicated hospital treatment course for severe autoimmune blistering diseases.