Bullous pemphigoid presenting as dry gangrene in a revascularized limb

Bullous pemphigoid (BP) is the most common autoimmune blistering disease, and has been associated with many diseases; most autoimmune. It has never previously been associated with a reperfused limb. A 74-year-old female underwent a right femoroanterior tibial polytetrafluoroethylene (PTFE) bypass for tissue loss and rest pain in the right foot. After surgery she was treated for recurrent infection which exacerbated tissue loss and was eventually diagnosed as BP. There was a delay in diagnosis due to the similarity to dry gangrene. This case highlights the potential difficulties of BP diagnosis in a revascularized limb and the importance of multidisciplinary management of atypical infection