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.

Increasing awareness of sudden unexpected death in epilepsy.

Epilepsy affects about 1 in 130 people in the UK and most have a normal life expectancy. Sudden unexpected death in epilepsy (SUDEP) is a - probably heterogeneous - condition where patients with epilepsy die suddenly, almost certainly during a seizure and with no other identified cause of death. The mechanism(s) of SUDEP remain uncertain, but with a growing international scientific interest, there is reason to be optimistic that eventually most of the likely several causes will be identified. Increasing awareness of SUDEP has generated efforts to understand the underlying pathophysiology of SUDEP better to direct the search for effective preventative measures. This review addresses the epidemiology of SUDEP, its possible underlying mechanisms, risk factors, clinical implications and future directions for research.