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Stojičić M, Jurišić M, Marinković M, Karamarković M, Jovanović M, Jeremić J, Jović M, Vlahović A, Jovanović M, Radenović K, Jovićević N, Vasović D. Necrotizing Fasciitis-Severe Complication of Bullous Pemphigoid: A Systematic Review, Risk Factors, and Treatment Challenges. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040745. [PMID: 37109703 PMCID: PMC10144771 DOI: 10.3390/medicina59040745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 03/25/2023] [Accepted: 04/05/2023] [Indexed: 04/29/2023]
Abstract
Background and objectives: Bullous pemphigoid (BP), the most common subepidermal autoimmune skin blistering disease (AIBD) has an estimated annual incidence of 2.4 to 42.8 new cases per million in different populations, designating it an orphan disease. Characterized by disruption of the skin barrier combined with therapy-induced immunosuppression, BP could pose a risk for skin and soft tissue infections (SSTI). Necrotizing fasciitis (NF) is a rare necrotizing skin and soft tissue infection, with a prevalence of 0.40 cases per 100,000 to 15.5 cases per 100,000 population, often associated with immunosuppression. Low incidences of NF and BP classify them both as rare diseases, possibly contributing to the false inability of making a significant correlation between the two. Here, we present a systematic review of the existing literature related to the ways these two diseases correlate. Materials and methods: This systematic review was conducted according to the PRISMA guidelines. The literature review was conducted using PubMed (MEDLINE), Google Scholar, and SCOPUS databases. The primary outcome was prevalence of NF in BP patients, while the secondary outcome was prevalence and mortality of SSTI in BP patients. Due to the scarcity of data, case reports were also included. Results: A total of 13 studies were included, six case reports of BP complicated by NF with six retrospective studies and one randomized multicenter trial of SSTIs in BP patients. Conclusions: Loss of skin integrity, immunosuppressive therapy, and comorbidities commonly related to BP patients are risk factors for necrotizing fasciitis. Evidence of their significant correlation is emerging, and further studies are deemed necessary for the development of BP-specific diagnostic and treatment protocols.
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Affiliation(s)
- Milan Stojičić
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Milana Jurišić
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Milana Marinković
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Miodrag Karamarković
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Milan Jovanović
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Jelena Jeremić
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Marko Jović
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Aleksandar Vlahović
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Institute for Mother and Child Health Care of Serbia, 11000 Belgrade, Serbia
| | - Mladen Jovanović
- Clinic for Plastic and Reconstructive Surgery, Clinical Center of Vojvodina, 21000 Novi Sad, Serbia
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
| | - Kristina Radenović
- Clinic for Burns, Plastic and Reconstructive Surgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Nikola Jovićević
- Clinic for Neurosurgery, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Dolika Vasović
- Clinic for Eye Diseases, University Clinical Center of Serbia, 11000 Belgrade, Serbia
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Chen J, Mao X, Zhao W, Zhang B, Chen X, Yu C, Zheng Z, Jin H, Li L. Assessment of the Characteristics and Associated Factors of Infectious Complications in Bullous Pemphigoid. Front Immunol 2020; 11:1607. [PMID: 32793235 PMCID: PMC7390841 DOI: 10.3389/fimmu.2020.01607] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/16/2020] [Indexed: 12/13/2022] Open
Abstract
Objectives: The clinical outcome of bullous pemphigoid appears worse in patients with infectious complications, and assessment of the prevalence and risk factors of infectious complications could be necessary to plan preventative strategies and to instruct the treatment plans. We sought to determine the risk factors of infection and compare associated factors in inpatients and outpatients with different system infections. Design: This is a single-centered retrospective study on the medical records of 252 patients from 2010 to 2018 at the dermatology department, Peking Union Medical College. Medical profiles of medical history, diagnosis, infectious complications, and treatment plans were analyzed. The associated factors were compared between the subgroups, including inpatients and outpatients, different body sites of infection. Results: Of the total 252 patients with bullous pemphigoid (BP), 81 patients (81/252, 32.1%) had infectious complications. Forty-eight patients died from pulmonary infections (11/48, 22.9%), cardiovascular diseases (6/48, 12.5%), and other diseases. Infections were most frequently found in skin/mucosa (44/252, 17.5%), respiratory system (32/252, 12.7%), and blood (10/252, 4.0%). On multivariate analysis, risk factors of infections in BP were maximal control dose of corticosteroids (OR 2.539, 95% CI 1.456-4.430, p = 0.001), low serum albumin level (OR 2.557, 95% CI 1.283, 5.092, p = 0.007), hospitalization (OR 4.025, 95% CI 2.289, 7.079, p < 0.001), comorbidities including respiratory disease (OR 4.060, 95% CI, 1.861, 8.858, p < 0.001), eye disease (OR 4.431, 95% CI 1.864, 10.532, p < 0.001), and diabetes (OR 2.667, 95% CI 1.437, 4.949, p = 0.002). The rate of infection was significantly higher in inpatients compared to that in outpatients (54.0 vs. 20.6%, p < 0.001), with diverse risk factors. Mucocutaneous infections were associated with a maximal control dose of corticosteroid and other dermatoses. Respiratory infections were related to respiratory disease and old age, and hematologic infection was associated with low serum hemoglobin levels and mucosal involvement of BP. Both of them were associated with mucosal involvement of BP and high titer anti-BP180 antibody. Conclusions: Infectious complications of bullous pemphigoid are common and are associated with mucosal involvement of BP, more comorbidities, the higher dose of corticosteroids, and the lower level of serum albumin.
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Affiliation(s)
- Jia Chen
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuming Mao
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, United States
| | - Wenling Zhao
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Dermatology, Shunyi Maternal and Children's Hospital of Beijing Children's Hospital, Beijing, China
| | - Bingjie Zhang
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xinyi Chen
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chenyang Yu
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zehui Zheng
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongzhong Jin
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Li Li
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Murrell DF. Screening for infections prior to initiating immunosuppressive treatment for patients with autoimmune blistering diseases. Br J Dermatol 2016; 171:1285-6. [PMID: 25523248 DOI: 10.1111/bjd.13451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- D F Murrell
- Department of Dermatology, St George Hospital, University of New South Wales, Gray Street, Kogarah, Sydney, NSW, 2217, Australia; Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
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Opportunistic infections in patients with pemphigus. J Am Acad Dermatol 2014; 71:284-92. [DOI: 10.1016/j.jaad.2014.03.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Revised: 03/12/2014] [Accepted: 03/16/2014] [Indexed: 11/19/2022]
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Lehman JS, Khunger M, Lohse CM. Infection in autoimmune bullous diseases: A retrospective comparative study. J Dermatol 2013; 40:613-9. [DOI: 10.1111/1346-8138.12175] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 03/21/2013] [Indexed: 12/27/2022]
Affiliation(s)
- Julia S. Lehman
- Division of Dermatopathology and Cutaneous Immunopathology; Department of Dermatology; Mayo Clinic; Rochester; Minnesota; USA
| | - Monica Khunger
- All India Institute of Medical Sciences; New Delhi; India
| | - Christine M. Lohse
- Division of Biomedical Statistics and Informatics; Mayo Clinic; Rochester; Minnesota; USA
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Lehman JS, Murrell DF, Camilleri MJ, Kalaaji AN. Infection and Infection Prevention in Patients Treated with Immunosuppressive Medications for Autoimmune Bullous Disorders. Dermatol Clin 2011; 29:591-8. [DOI: 10.1016/j.det.2011.06.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Corredoira JM, Ariza J, Pallarés R, Carratalá J, Viladrich PF, Rufí G, Verdaguer R, Gudiol F. Gram-negative bacillary cellulitis in patients with hepatic cirrhosis. Eur J Clin Microbiol Infect Dis 1994; 13:19-24. [PMID: 8168554 DOI: 10.1007/bf02026118] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Eight episodes of gram-negative bacillary cellulitis in seven patients with hepatic cirrhosis are reported. The patients comprised five women and two men (mean age 59.6 years). The diagnosis was based on a positive culture of specimens obtained by needle aspiration from cutaneous lesions. All patients had grade C cirrhosis according to Pugh's classification. Cellulitis involved the lower extremities in all cases. Five patients developed bullous lesions, three ulcers, two abscesses and two extensive cutaneous necrosis. A single bacterial species was found in seven cases. Organisms isolated were Klebsiella pneumoniae (3 cases), Escherichia coli (2 cases), Pseudomonas aeruginosa (2 cases), Proteus mirabilis (1 case) and Aeromonas hydrophila (1 case). Bacteremia was documented in six cases. Four patients died, death being related to sepsis in three of them. It is concluded that gram-negative bacilli should be considered as possible pathogens in severe infectious cellulitis in patients with advanced cirrhosis. Microbiological study of cutaneous specimens obtained by needle aspiration may be of high diagnostic value in these cases.
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Affiliation(s)
- J M Corredoira
- Department of Infectious Diseases, Hospital de Bellvitge, Universidad de Barcelona, Spain
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Sobh MA, Hamid IAA, Saad HM, Eid MM, Razic MMA, Elshamy S, Ghoniem MA. Dermatologic complications in renal transplant recipients versus uraemic patients under maintenance haemodialysis treatment. J Eur Acad Dermatol Venereol 1992. [DOI: 10.1111/j.1468-3083.1992.tb00635.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
The human papillomavirus, well known as the etiologic agent of warts, has recently received much attention in the medical literature for its association with various cancers. This article discusses the virology, epidemiology, pathogenesis, immunology, clinical manifestations, and therapy for human papillomavirus infection. Some newer techniques for identifying human papillomavirus in tissue, based on recent advances in molecular biology, are also covered. Two final topics addressed are human papillomavirus infection in the immunocompromised host, including patients with acquired immunodeficiency syndrome, and the possible role of human papillomavirus in several different carcinomas.
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Affiliation(s)
- M W Cobb
- Department of Dermatology, National Naval Medical Center, Bethesda, MD 20814
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McMeekin TO, Moschella SL. Iatrogenic complications of dermatologic therapy. Primum non nocere. Med Clin North Am 1979; 63:441-52. [PMID: 86664 DOI: 10.1016/s0025-7125(16)31709-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Abstract
The clinical and laboratory findings in a patient constantly lacking eosinophil and basophil leucocytes in bone-marrow, blood, expectorates, and skin exudate are reported. He had repeated infections, asthma, haemolytic anaemia, vasomotor rhinitis, alopecia totalis, widespread scabies, and an extensive growth of warts. His IgA and IgE are low and this may account for some of the clinical features. When his plasma and serum were added in vitro the buffy coat of blood from other subjects, degranulation of eosinophils was seen within two hours. An immunological destruction of eosinophils and basophils is the most plausible explanation for their absence.
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