|
1
|
Schmidt V, Blum R, Möhrenschlager M. Biphasic bullous pemphigoid starting after first dose and boosted by second dose of mRNA-1273 vaccine in an 84-year-old female with polymorbidity and polypharmacy. J Eur Acad Dermatol Venereol 2021; 36:e88-e90. [PMID: 34606112 DOI: 10.1111/jdv.17722] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- V Schmidt
- Department of Dermatology, Hochgebirgsklinik Davos, Davos Wolfgang, Switzerland.,Christine Kühne Center for Allergy Research and Education, Davos, Switzerland
| | - R Blum
- Department of Dermatology, Inselspital, University of Bern, Bern, Switzerland
| | - M Möhrenschlager
- Department of Dermatology, Hochgebirgsklinik Davos, Davos Wolfgang, Switzerland
| |
Collapse
|
|
2
|
Biondo MI, Fiorentino C, Persechino S, Tammaro A, Koverech A, Bartolazzi A, Raffa S, Canzoni M, Picchianti-Diamanti A, Di Rosa R, Di Zenzo G, Scala E, Meneguzzi G, Ferlito C, Markovic M, Caporuscio S, Sorgi ML, Salemi S, Laganà B. May Bacterial Infections Trigger Bullous Pemphigoid? Case Report and Review of Literature. Microorganisms 2021; 9:microorganisms9061235. [PMID: 34200214 PMCID: PMC8229970 DOI: 10.3390/microorganisms9061235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 05/29/2021] [Accepted: 06/04/2021] [Indexed: 01/31/2023] Open
Abstract
Bullous pemphigoid (BP) is an autoimmune blistering skin disease, mainly observed in the elderly. Infections have been suggested as possible disease triggers. However, infections may even heavily influence the disease clinical course and mortality. A 75-year-old woman was admitted to hospital for severe erythematosus blistering disease, accompanied by hyper-eosinophilia and hyper-IgE. The culture of bullous fluid was positive for Enterococcus faecalis, the blood culture was positive for Staphylococcus aureus, and the urine culture was positive for Proteus mirabilis and Escherichia coli. Moreover, circulating anti-BP180 IgG was present and the histopathological/ultrastructural examination of a lesional skin biopsy was compatible with BP. High eosinophil levels (up to 3170/µL) were found throughout the clinical course, while values below 1000/µL were associated with clinical improvement. The total IgE was 1273 IU/mL, and specific anti-G/V-penicillin/ampicillin IgE antibodies were positive. The patient had a complete clinical recovery in two months with methyl-prednisolone (40 then 20 mg/day) and low-dose azathioprine (50 mg/day) as a steroid-sparing agent. The steroid treatment was tapered until interruption during a one-year period and intravenous immunoglobulins have been administered for three years in order for azathioprine to also be interrupted. The patient stopped any treatment five years ago and, in this period, has always been in good health. In this case, the contemporaneous onset of different bacterial infections and BP is suggestive of bacterial infections acting as BP trigger(s), with allergic and autoimmune pathways contributing to the disease pathogenesis.
Collapse
Affiliation(s)
- Michela Ileen Biondo
- Dipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.I.B.); (C.F.); (A.K.); (A.B.); (S.R.); (M.C.); (A.P.-D.); (R.D.R.); (G.M.); (C.F.); (M.M.); (S.C.); (M.L.S.)
| | - Chiara Fiorentino
- Dipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.I.B.); (C.F.); (A.K.); (A.B.); (S.R.); (M.C.); (A.P.-D.); (R.D.R.); (G.M.); (C.F.); (M.M.); (S.C.); (M.L.S.)
| | - Severino Persechino
- UOD di Dermatologia, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (S.P.); (A.T.)
| | - Antonella Tammaro
- UOD di Dermatologia, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (S.P.); (A.T.)
| | - Angela Koverech
- Dipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.I.B.); (C.F.); (A.K.); (A.B.); (S.R.); (M.C.); (A.P.-D.); (R.D.R.); (G.M.); (C.F.); (M.M.); (S.C.); (M.L.S.)
| | - Armando Bartolazzi
- Dipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.I.B.); (C.F.); (A.K.); (A.B.); (S.R.); (M.C.); (A.P.-D.); (R.D.R.); (G.M.); (C.F.); (M.M.); (S.C.); (M.L.S.)
| | - Salvatore Raffa
- Dipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.I.B.); (C.F.); (A.K.); (A.B.); (S.R.); (M.C.); (A.P.-D.); (R.D.R.); (G.M.); (C.F.); (M.M.); (S.C.); (M.L.S.)
| | - Marco Canzoni
- Dipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.I.B.); (C.F.); (A.K.); (A.B.); (S.R.); (M.C.); (A.P.-D.); (R.D.R.); (G.M.); (C.F.); (M.M.); (S.C.); (M.L.S.)
| | - Andrea Picchianti-Diamanti
- Dipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.I.B.); (C.F.); (A.K.); (A.B.); (S.R.); (M.C.); (A.P.-D.); (R.D.R.); (G.M.); (C.F.); (M.M.); (S.C.); (M.L.S.)
| | - Roberta Di Rosa
- Dipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.I.B.); (C.F.); (A.K.); (A.B.); (S.R.); (M.C.); (A.P.-D.); (R.D.R.); (G.M.); (C.F.); (M.M.); (S.C.); (M.L.S.)
| | - Giovanni Di Zenzo
- Istituto Dermopatico dell’Immacolata, 00167 Roma, Italy; (G.D.Z.); (E.S.)
| | - Enrico Scala
- Istituto Dermopatico dell’Immacolata, 00167 Roma, Italy; (G.D.Z.); (E.S.)
| | - Giorgia Meneguzzi
- Dipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.I.B.); (C.F.); (A.K.); (A.B.); (S.R.); (M.C.); (A.P.-D.); (R.D.R.); (G.M.); (C.F.); (M.M.); (S.C.); (M.L.S.)
| | - Claudia Ferlito
- Dipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.I.B.); (C.F.); (A.K.); (A.B.); (S.R.); (M.C.); (A.P.-D.); (R.D.R.); (G.M.); (C.F.); (M.M.); (S.C.); (M.L.S.)
| | - Milica Markovic
- Dipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.I.B.); (C.F.); (A.K.); (A.B.); (S.R.); (M.C.); (A.P.-D.); (R.D.R.); (G.M.); (C.F.); (M.M.); (S.C.); (M.L.S.)
| | - Sara Caporuscio
- Dipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.I.B.); (C.F.); (A.K.); (A.B.); (S.R.); (M.C.); (A.P.-D.); (R.D.R.); (G.M.); (C.F.); (M.M.); (S.C.); (M.L.S.)
| | - Maria Laura Sorgi
- Dipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.I.B.); (C.F.); (A.K.); (A.B.); (S.R.); (M.C.); (A.P.-D.); (R.D.R.); (G.M.); (C.F.); (M.M.); (S.C.); (M.L.S.)
| | - Simonetta Salemi
- Dipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.I.B.); (C.F.); (A.K.); (A.B.); (S.R.); (M.C.); (A.P.-D.); (R.D.R.); (G.M.); (C.F.); (M.M.); (S.C.); (M.L.S.)
- Correspondence: (S.S.); (B.L.)
| | - Bruno Laganà
- Dipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, Italy; (M.I.B.); (C.F.); (A.K.); (A.B.); (S.R.); (M.C.); (A.P.-D.); (R.D.R.); (G.M.); (C.F.); (M.M.); (S.C.); (M.L.S.)
- Correspondence: (S.S.); (B.L.)
| |
Collapse
|
|
3
|
Moro F, Fania L, Sinagra JLM, Salemme A, Di Zenzo G. Bullous Pemphigoid: Trigger and Predisposing Factors. Biomolecules 2020; 10:E1432. [PMID: 33050407 PMCID: PMC7600534 DOI: 10.3390/biom10101432] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/01/2020] [Accepted: 10/08/2020] [Indexed: 12/14/2022] Open
Abstract
Bullous pemphigoid (BP) is the most frequent autoimmune subepidermal blistering disease provoked by autoantibodies directed against two hemidesmosomal proteins: BP180 and BP230. Its pathogenesis depends on the interaction between predisposing factors, such as human leukocyte antigen (HLA) genes, comorbidities, aging, and trigger factors. Several trigger factors, such as drugs, thermal or electrical burns, surgical procedures, trauma, ultraviolet irradiation, radiotherapy, chemical preparations, transplants, and infections may induce or exacerbate BP disease. Identification of predisposing and trigger factors can increase the understanding of BP pathogenesis. Furthermore, an accurate anamnesis focused on the recognition of a possible trigger factor can improve prognosis by promptly removing it.
Collapse
Affiliation(s)
- Francesco Moro
- Correspondence: (F.M.); (L.F.); Tel.: +39-(342)-802-0004 (F.M.)
| | - Luca Fania
- Correspondence: (F.M.); (L.F.); Tel.: +39-(342)-802-0004 (F.M.)
| | | | | | | |
Collapse
|