Bullous scabies with bullous pemphigoid

We report a rare case of bullous scabies with bulious pemphigoid in a 59-year-old male patient. He presented with a 9-month history of exhibiting multiple, variable-sized, red-to-brown, pruritic cutaneous patches, and papules with tense bullae on his whole body. A direct smear of the bullous lesions was performed and was negative for scabies mites. Histopathologic findings (hematoxylin and eosin staining) revealed Sarcoptes scabiei in the stratum comeum. There were sub-epidermal blisters with massive eosinophil and lymphocyte infiltration in the epidermis and upper dennis. Direct inimunofluorescence microscopy showed linear deposition of IgG at the dermo-epidennal junction. Indirect iminunofluorescence microscopy of samples acquired for the salt-split skin test showed linear IgG deposition in the epidermis. Skin lesions improved after the patient was treated with an anti-scabietic and steroids.