We describe a case of a 16-year-old African-American boy with bullous pemphigoid (BP), an acquired autoimmune blistering disease that is rarely seen in children. The patient's lesions, however, were distinctly herpetiform, complicating initial diagnosis and therapy. A diagnosis of BP was made by direct and indirect immunofluorescence. Immunoblotting and enzyme-linked immunosorbent assay analysis confirmed the presence of autoantibodies directed against the BP180 antigen. The autoantibodies reacted with the same epitopes within the immunodominant BP180 NC16A domain that have previously been shown to be the target of autoantibodies in BP. This case describes an uncommon disease in the pediatric population and should be included in the differential diagnosis in young patients with an unusual generalized vesicular eruption.
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