Bullous Pemphigoid Following Total Hip Arthroplasty With Subsequent Prosthetic Joint Infection: Literature Review

Bullous pemphigoid (BP) is an autoimmune blistering disorder potentially triggered by surgery or perioperative medications. An 88-year-old man underwent uncomplicated anterior total hip arthroplasty for femoral neck fracture. Five weeks later, pruritic tense bullae appeared around the operative site. Histology demonstrated subepidermal blistering with eosinophils; direct immunofluorescence revealed linear basement-membrane IgG and C3, confirming BP. Immunosuppression was initiated. Five weeks thereafter, fever, erythema, tenderness, and effusion developed. Purulent aspirate grew Staphylococcus aureus, confirming prosthetic joint infection. Despite urgent debridement and intravenous antibiotics, persistent infection required explantation and antibiotic spacer placement three weeks later. After clinical improvement over three months, planned second-stage reimplantation was completed without BP recurrence. To our knowledge, this first reported complication highlights prompt dermatologic diagnosis, judicious immunosuppression, and multidisciplinary management following arthroplasty.