2026 Clinician Corner - Bullous pemphigoid preceding the diagnosis of colorectal adenocarcinoma

Abstract 

Bullous pemphigoid (BP) is a rare autoimmune skin disorder most commonly seen in older adults. It is marked by subepidermal blistering due to autoantibodies targeting hemidesmosomal proteins. While often idiopathic, BP has occasionally been linked to internal malignancies. We present the case of a 77-year-old man whose diagnosis of BP led to the detection of invasive colorectal adenocarcinoma. This case highlights the need for malignancy screening in patients with atypical dermatologic presentations and systemic symptoms.  

Keywords:  Adenocarcinoma; bullous pemphigoid; colorectal; paraneoplastic

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Faculty credentials/disclosure 

The planners and faculty for this activity have no relevant financial relationships to disclose. The patient consented to the publication of this report.

Process

Click the "add to cart/begin" button, pay any relevant fee, take the quiz, complete the evaluation, and claim your CME credit.  You must achieve 100% on the quiz with unlimited attempts available.

  • By completing this process, you are attesting that you have read the journal article.

Expiration date:

Credit eligibility for this article is set to expire on May 1, 2027.

Learning Objectives

After completing the article, the learner should be able to:

  • Recognize the diagnostic features and immunopathology of bullous pemphigoid. 

  • Apply nonimmunosuppressive management strategies (e.g., doxycycline + niacinamide) in elderly or comorbid patients. 

  • Identify clinical clues that warrant malignancy screening in bullous pemphigoid. 

Key Points 

  • In rare instances, bullous pemphigoid may function as a paraneoplastic marker, particularly in the presence of persistent systemic symptoms. 

  • Identification of dermatological symptoms may assist in early cancer detection and interdisciplinary treatment. 

  • A comprehensive malignancy screening should be prompted by atypical signs, such as iron deficiency anemia or persistent gastrointestinal problems. 

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Course summary
Available credit: 
  • 1.00 American Board of Internal Medicine (ABIM) MOC Part 2
    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.00 MOC points in the American Board of Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.
  • 1.00 American Board of Surgery (ABS) Accredited CME
    Successful completion of this CME activity enables the learner to earn credit toward the CME requirement of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.
  • 1.00 AMA PRA Category 1 Credit™
    The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
  • 1.00 Attendance
Course opens: 
05/01/2026
Course expires: 
05/01/2027
Cost:
$25.00

Rebecca Joseph, BS¹, Lesly Martinez Artiga, MD², Milcah Poothakary, BA¹, Ben Thiravetyan, MD³, and Drew Payne, DO³ 

 

¹ School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA 
²Universidad Evangelica de El Salvador, San Salvador, El Salvador 
³Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA 

 

Corresponding Author: Milcah Poothakary, BA, School of Medicine, Texas Tech University Health Sciences Center, 3601 4th St., Lubbock, TX 79430 (e-mail: [email protected]) 

The planners and faculty for this activity have no relevant financial relationships to disclose. The authors report no funding. The patient consented to publication of this case report. 

Accreditation

The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Designation

AMA PRA Category 1 Credit™

The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ABS CC

Successful completion of this CME activity enables the learner to earn credit toward the CME requirement of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.

ABIM MOC

 Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

Available Credit

  • 1.00 American Board of Internal Medicine (ABIM) MOC Part 2
    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.00 MOC points in the American Board of Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.
  • 1.00 American Board of Surgery (ABS) Accredited CME
    Successful completion of this CME activity enables the learner to earn credit toward the CME requirement of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.
  • 1.00 AMA PRA Category 1 Credit™
    The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
  • 1.00 Attendance

Price

Cost:
$25.00
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