Bullosis Diabeticorum as a Cutaneous Marker of Advanced Microangiopathy: A Case Report from Southern Nigeria

Background: Bullosis diabeticorum (BD) is a rare, spontaneous, non-inflammatory blistering disorder occurring in patients with diabetes mellitus. Although classically described as a benign cutaneous condition, accumulating evidence suggests that BD may represent a marker of advanced systemic microvascular disease. Recent literature emphasises the role of diabetic microangiopathy and neuropathy in te pthogenesid of BD and related cutaneous complication. Case Presentation: We report a 76-year-old woman with a 30-year history of poorly controlled type 2 diabetes mellitus who presented with spontaneous tense bullae that progressed to infected ulcers. Lesions involved the lower limbs, gluteal region, and trunk. Laboratory evaluation revealed hyperglycemia (HbA1c 9.8%), leukocytosis, and chronic kidney disease (serum creatinine 1.9 mg/dL, proteinuria). Histopathology demonstrated a subepidermal blister with minimal inflammatory infiltrate, confirming BD. Multidisciplinary management involving glycemic optimisation, renal-adjusted antibiotic therapy, and structured wound care resulted in gradual healing. Conclusion: BD should not be viewed solely as a dermatologic entity but as a potential cutaneous marker of systemic microangiopathy, including diabetic kidney disease. Early recognition and integrated dermatologic–nephrologic care are essential to prevent morbidity.