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de Oliveira JP, Gabbi TVB, Hashimoto T, Aoki V, Santi CG, Maruta CW, Rivitti EA, Reis VMS. Two Brazilian Cases of IgA Pemphigus. J Dermatol 2014; 30:886-91. [PMID: 14739515 DOI: 10.1111/j.1346-8138.2003.tb00343.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2003] [Accepted: 08/26/2003] [Indexed: 11/29/2022]
Abstract
IgA pemphigus is a rare, neutrophilic, acantholytic skin disorder with approximately 70 cases described in the literature. We report two patients with the subcorneal pustular dermatosis (SPD) type of IgA pemphigus. Initially, both patients were misdiagnosed as subcorneal pustular dermatosis of Sneddon and Wilkinson. The correct diagnosis was only made after detecting intercellular IgA depositions in the epidermis by direct immunofluorescence. Immunoblotting (IB) of normal human epidermal extracts, performed on both sera, was negative for Dsg 1, Dsg 3, BP 230, BP 180, 210 kDa envoplakin, and 190 kDa periplakin. ELISA for desmogleins (Dsg 1 and Dsg 3) showed that neither of the cases had IgA antibodies to Dsg. The c-DNA transfection test for desmocollins (Dsc) revealed that the IgA antibodies of both patients reacted with desmocollin 1. This result supports the hypothesis that the autoantigen in SPD type IgA pemphigus is desmocollin 1.
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Abstract
The presence of one autoimmune disorder helps lead to the discovery of other autoimmune conditions. It is thought that diseases in which autoimmunity is a feature tend to be associated together more often than one can ascribe to chance. A variety of diseases have been implicated in the onset of intraepidermal and subepidermal autoimmune diseases. The presence of one autoimmune disease should alert the physician to watch for a second immunologic disorder. A list of autoimmune bullous diseases associations includes autoimmune bullous diseases, pemphigus, pemphigoid, epidermolysis bullosa acquisita, dermatitis herpetiformis (Duhring), linear immunoglobulin A disease, and multiple autoimmune syndrome.
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Affiliation(s)
- Suzana Ljubojevic
- University Department of Dermatology and Venereology, University Hospital Center Zagreb, School of Medicine,University of Zagreb, Croatia.
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Suzuki M, Karube S, Kobori Y, Usui K, Murata S, Kato H, Nakagawa H. IgA pemphigus occurring in a 1-month-old infant. J Am Acad Dermatol 2003; 48:S22-4. [PMID: 12582378 DOI: 10.1067/mjd.2003.119] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
An 11-month-old girl had recurrent pruritic vesiculopustular lesions involving the trunk, extremities, and scalp since the age of 1-month. Histopathologic examination revealed an intraepidermal bulla produced by acantholysis and neutrophilic spongiosis. Direct immunofluorescence showed IgA deposits in the intercellular space throughout the epidermis. Circulating anti-intercellular IgA autoantibodies were absent. Dapsone therapy was effective.
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Affiliation(s)
- Masayuki Suzuki
- Department of Dermatology, Jichi Medical School, Yakushiji Minamikawachimachi Kawachigun Tochigi, Japan.
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Abstract
The accurate diagnosis of bullous and other immune diseases of the skin requires evaluation of clinical, histologic, and immunofluorescence findings. Immunofluorescence testing is invaluable in confirming a diagnosis that is suspected by clinical or histologic examination. This is especially true in subepidermal bullous diseases that often have overlap in the clinical and histologic findings. Direct immunofluorescence is performed on perilesional skin for patients with bullous diseases and lesional skin for patients with connective tissue diseases and vasculitis.
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Affiliation(s)
- D F Mutasim
- Department of Dermatology, University of Cincinnati, Ohio 45267-0592, USA.
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Affiliation(s)
- T Hashimoto
- Department of Dermatology, Kurume University School of Medicine, Fukuoka, Japan.
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Niimi Y, Kawana S, Kusunoki T. IgA pemphigus: a case report and its characteristic clinical features compared with subcorneal pustular dermatosis. J Am Acad Dermatol 2000; 43:546-9. [PMID: 10954673 DOI: 10.1067/mjd.2000.107478] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We report a case of IgA pemphigus. A 35-year-old woman had vesiculopustular eruptions on her scalp, trunk, and extremities. Histologic examination showed a subcorneal pustule containing numerous neutrophils without acantholysis. Direct immunofluorescence revealed IgA deposits in the intercellular space throughout the epidermis, more intense in superficial layers and less intense in lower layers. The titer of circulating IgA antibodies was 1:160 in normal human skin as a substrate. Skin lesions responded to dapsone. The IgA autoantibody from this patient did not react with desmogleins or desmocollins when immunoblotting, enzyme-linked immunosorbent assay, or complement DNA transfection was used. We consider the characteristic clinical features that favor the diagnosis of IgA pemphigus rather than classic subcorneal pustular dermatosis as follows: (1) the lesions involve the scalp and/or face, and (2) the distribution of the lesions is more widespread.
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Affiliation(s)
- Y Niimi
- Department of Dermatology, Nippon Medical School, and Kusunoki Dermatology Clinic, Tokyo, Japan
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Yasuda H, Kobayashi H, Hashimoto T, Itoh K, Yamane M, Nakamura J. Subcorneal pustular dermatosis type of IgA pemphigus: demonstration of autoantibodies to desmocollin-1 and clinical review. Br J Dermatol 2000; 143:144-8. [PMID: 10886149 DOI: 10.1046/j.1365-2133.2000.03604.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We describe a 40-year-old Japanese man with a 3-year history of vesiculopustular lesions resembling subcorneal pustular dermatosis. Histopathology showed subcorneal pustules containing a few acantholytic cells, and direct immunofluorescence disclosed IgA deposition in the intercellular space of the upper epidermis. Circulating IgA autoantibodies of very low titre were also demonstrated by indirect immunofluorescence. A novel cDNA transfection technique clearly detected IgA autoantibodies reactive with human desmocollin-1. Combined therapy with dapsone and etretinate improved the skin lesions. We review the clinical features of 49 patients in the literature who presented with vesiculopustular lesions and intraepidermal IgA deposition.
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Affiliation(s)
- H Yasuda
- Department of Dermatology, Sapporo Social Insurance General Hospital, 2-1, 2-Jo, 6-Chome, Atsubetsu Chuo, Atsubetsu, Sapporo 004-8618, Japan
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Affiliation(s)
- T Nishikawa
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
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Kim SC, Won JH, Chung J, Bang DS. IgA pemphigus: report of a case with immunoelectron localization of bound IgA in the skin. J Am Acad Dermatol 1996; 34:852-4. [PMID: 8632087 DOI: 10.1016/s0190-9622(96)90044-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- S C Kim
- Department of Dermatology, Yonsei University College of Medicine, Seoul, Korea
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Abstract
A 12-year-old girl with ulcerative colitis (UC) treated by colectomy with rectal stump preservation, salazopyrin, and systemic steroids developed persistent mouth ulcers, cutaneous targetlike lesions, papulopustules, and bullae. The clinical, histologic, and immunopathologic features were typical of chronic bullous disease of childhood (CBDC). Although resistant to combined immunosuppressive therapy with low-dose prednisolone, cyclosporin, and thalidomide, striking remission of the mucocutaneous symptoms resulted with surgical resection of the diseased rectal stump. An etiologic association between CBDC and UC is postulated.
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Affiliation(s)
- J Handley
- Department of Dermatology, Royal Victoria Hospital, Belfast, North Ireland
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Akiyama M, Hashimoto T, Sugiura M, Nishikawa T. Ultrastructural localization of autoantigens of intercellular IgA vesiculopustular dermatosis in cultured human squamous cell carcinoma cells. Arch Dermatol Res 1992; 284:371-3. [PMID: 1294027 DOI: 10.1007/bf00372043] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- M Akiyama
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
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Abstract
Since 1979, 29 patients with intraepidermal IgA detected by direct immunofluorescence have been reported. A review shows that they have a cutaneous disease clinically similar to subcorneal pustular dermatosis, or Sneddon-Wilkinson disease. The pustules may be subcorneal or intraepidermal. IgA deposits are usually found on the intercellular substance of the epidermis, although a subcorneal linear pattern has also been described. Circulating IgA class antiepidermal autoantibodies may be present. The disease usually responds to dapsone. In six cases, a monoclonal IgA gammopathy was present. Although little is known about the pathogenesis of this condition, we believe that it represents a distinct entity among the group of the neutrophilic dermatoses. Various diagnostic terms have been used; we propose intraepidermal IgA pustulosis.
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Affiliation(s)
- D Wallach
- Department of Dermatology, Hôpital Saint-Louis, Paris, France
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Borradori L, Saada V, Rybojad M, Flageul B, Kuffer R, Lémann M, Verola O, Modigliani R, Morel P. Oral intraepidermal IgA pustulosis and Crohn's disease. Br J Dermatol 1992; 126:383-6. [PMID: 1571262 DOI: 10.1111/j.1365-2133.1992.tb00685.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A case is reported of a 60-year-old woman with Crohn's disease who developed recurrent oral blisters and erosions. The histopathology of the buccal mucosa showed intraepidermal bullae and clefts with an intense accumulation of neutrophils in the epithelium. Direct immunofluorescence revealed intercellular IgA predominantly in the basal and suprabasal layers and in one biopsy concurrent deposits of IgG. No circulating autoantibodies were detected.
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Affiliation(s)
- L Borradori
- Department of Dermatology, Hôpital Saint Louis, University of Paris VII, France
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Prost C, Intrator L, Wechsler J, Lebbe C, Bagot M, Roujeau JC, Dubertret L, Revuz J. IgA autoantibodies bind to pemphigus vulgaris antigen in a case of intraepidermal neutrophilic IgA dermatosis. J Am Acad Dermatol 1991; 25:846-8. [PMID: 1802908 DOI: 10.1016/s0190-9622(08)80980-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- C Prost
- Dermatology Service, Hôpital Henri Mondor, Créteil, France
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Iwatsuki K, Takigawa M. Distinct types of IgG and IgA anti-intercellular autoantibodies from patients with pemphigus and vesiculopustular dermatosis. Br J Dermatol 1991; 125:335-9. [PMID: 1954122 DOI: 10.1111/j.1365-2133.1991.tb14167.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The pattern of binding of two different types of IgA class pemphigus-like antibodies was compared with that of the true IgG class pemphigus antibody. The IgG antibodies from pemphigus vulgaris (PV) and pemphigus foliaceus (PF) sera bound to the intercellular spaces in normal human epidermis, whereas only the PV antibody reacted with monolayers of keratinocytes derived from human foreskin. Both IgG and IgA antibodies from a patient with PF were found in the intercellular spaces of the epidermis and only the IgA antibody reacted with the cultured keratinocytes. The IgA antibody from a patient with a vesiculopustular eruption and whose serum contained IgA intercellular space antibody alone, bound to the upper epidermis but not to the monolayers of keratinocytes. These findings indicate that PV but not PF antigens can be expressed by monolayers of cultured human keratinocytes and that there are at least two distinct types of IgA intercellular antibodies.
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Affiliation(s)
- K Iwatsuki
- Department of Dermatology, Hamamatsu University School of Medicine, Japan
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Nishikawa T, Hashimoto T, Teraki Y, Ebihara T. The clinical and histopathological spectrum of IgA pemphigus. Clin Exp Dermatol 1991; 16:401-2. [PMID: 1794199 DOI: 10.1111/j.1365-2230.1991.tb00413.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Chorzelski TP, Beutner EH, Kowalewski C, Olszewska M, Maciejowska E, Seferowicz E, Kumar V, Jablonska S. IgA pemphigus foliaceus with a clinical presentation of pemphigus herpetiformis. J Am Acad Dermatol 1991; 24:839-44. [PMID: 1646833 DOI: 10.1016/0190-9622(91)70128-o] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A patient with clinical features of herpetiform pemphigus of the foliaceus type had histologic findings consistent with pemphigus. Intercellular IgA deposits in a pattern like that of IgG in pemphigus were present. Circulating pemphigus-type IgA-class antibodies reacted first only with guinea pig and later in the disease also with monkey esophagus sections. IgG-class pemphigus antibodies were blocked by the IgA-class antibodies of this patient. In addition, the IgA-class pemphigus antibodies in this patient were blocked by the IgG-class pemphigus antibodies in tests on guinea pig and monkey esophagus. This indicates that the IgA-class antibodies in this patient were directed either to the same antigen as the IgG-class pemphigus foliaceus antibodies or to one that is close enough to it to give steric hindrance. The skin lesions responded poorly to systemic corticosteroid therapy. Dapsone therapy initially produced dramatic improvement, but the condition flared to the point that plasmapheresis, in addition to high doses of corticosteroids and cyclophosphamide, had to be used to control it.
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Affiliation(s)
- T P Chorzelski
- Department of Dermatology, Warsaw Medical School, Poland
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Barlow RJ, Schulz EJ. Chronic subcorneal pustulosis with vasculitis: a variant of generalized pustular psoriasis in black South Africans. Br J Dermatol 1991; 124:470-4. [PMID: 2039724 DOI: 10.1111/j.1365-2133.1991.tb00628.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A rare, but distinctive chronic eruption in six female black South Africans is reported. The original diagnosis of subcorneal pustular dermatosis of Sneddon and Wilkinson in these patients was refuted by the subsequent histological observation of both spongiform pustules and an underlying vasculitis. This may represent a previously undocumented form of generalized pustular psoriasis.
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Affiliation(s)
- R J Barlow
- Medical University of Southern Africa, Pretoria, South Africa
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