1
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Bansari A, Wallace JA, Yang L, Kapoor A. Paraneoplastic pemphigus presenting as a prodrome to aggressive T cell lymphoma. BMJ Case Rep 2024; 17:e258580. [PMID: 38839409 DOI: 10.1136/bcr-2023-258580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024] Open
Abstract
Paraneoplastic pemphigus (PNP) is a rare disease with an unclear mechanism of pathogenesis. We present a case of a male patient who presented with wound management after being diagnosed with Castleman disease-associated paraneoplastic pemphigus (PNP). The patient's condition was not improving; as a result, extensive workup was repeated, which confirmed the diagnosis of aggressive T cell lymphoblastic lymphoma. Our case signifies the importance of keeping a high index of suspicion for PNP-associated malignancies. This case report also adds emphasis to the diagnostic challenges faced by clinicians, making clinical correlation with multidisciplinary approach essential. Therefore, if clinically indicated, we need to revisit the diagnosis and seek alternative explanations to prevent delays in management.
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Affiliation(s)
- Asha Bansari
- Medicine, University of Florida, Gainesville, Florida, USA
| | | | - Lijun Yang
- University of Florida, Gainesville, Florida, USA
| | - Atul Kapoor
- University of Florida, Gainesville, Florida, USA
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2
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Irrera M, Bozzola E, Cardoni A, DeVito R, Diociaiuti A, Hachem ME, Girardi K, Marchesi A, Villani A. Paraneoplastic pemphigus and Castleman's disease: a case report and a revision of the literature. Ital J Pediatr 2023; 49:33. [PMID: 36941723 PMCID: PMC10029234 DOI: 10.1186/s13052-023-01442-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 03/08/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND In literature, a few reports described an association between paraneoplastic pemphigus (PNP) and Castelman's disease (CD), but no consensus have been proposed for the diagnostic-therapeutical approach. Aim of this study is to present a case report and explore the relationship between PNP and CD in pediatric patients, focusing on clinical manifestations, histopathological findings, treatment and outcome to find elements for an early diagnosis. CASE PRESENTATION We present the clinical case of a 13 years old girl with a challenging diagnosis of PNP and CD who underwent therapy at first with Rituximab and then with Siltuximab, for the control of symptoms. CONCLUSIONS Reviewing literature, 20 clinical cases have been described in the pediatric age. Diagnosis may be challenging, requiring an average of 3 months (range from 3 weeks to 2 years). In all cases, the initial manifestations were mucocutaneous lesions, especially oral lesions with poor response to conventional treatment. Systemic symptoms may be present as well. Therapeutical approach is still discussed with no consensus. Almost all patients received corticosteroids with poor response. Other drugs including azathioprine, methotrexate, cyclosporine and monoclonal antibodies have been evaluated for the control of the disease. Further studies and experimental trials urge to define the diagnostic criteria and therapy protocol.
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Affiliation(s)
| | - Elena Bozzola
- Pediatric Unit, IRCCS Bambino Gesù Children's Hospital, Rome, Italy.
| | - Antonello Cardoni
- Unity of Pathology, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Rita DeVito
- Unity of Pathology, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Andrea Diociaiuti
- Dermatology Unit and Genodermatosis Unit, Genetics and Rare Diseases Research Division, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Maya El Hachem
- Dermatology Unit and Genodermatosis Unit, Genetics and Rare Diseases Research Division, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Katia Girardi
- Department of Pediatric Hematology/Oncology and Cell and Gene Therapy, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Alberto Villani
- Pediatric Unit, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
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3
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Relvas M, Xará J, Lucas M, Coelho S, Coutinho I, Cardoso JC, Ramos L. Paraneoplastic pemphigus associated with Castleman's disease. J Paediatr Child Health 2023; 59:573-576. [PMID: 36718585 DOI: 10.1111/jpc.16361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/11/2023] [Accepted: 01/23/2023] [Indexed: 02/01/2023]
Affiliation(s)
- Maria Relvas
- Dermatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Joana Xará
- Dermatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Miguel Lucas
- Department of Pediatrics, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Sónia Coelho
- Dermatology Department, Centro Hospitalar Tondela-Viseu, Viseu, Portugal
| | - Inês Coutinho
- Dermatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - José C Cardoso
- Dermatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Leonor Ramos
- Dermatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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Nishimura MF, Nishimura Y, Nishikori A, Maekawa Y, Maehama K, Yoshino T, Sato Y. Clinical and Pathological Characteristics of Hyaline-Vascular Type Unicentric Castleman Disease: A 20-Year Retrospective Analysis. Diagnostics (Basel) 2021; 11:diagnostics11112008. [PMID: 34829355 PMCID: PMC8618395 DOI: 10.3390/diagnostics11112008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/22/2021] [Accepted: 10/25/2021] [Indexed: 12/11/2022] Open
Abstract
The first case of hyaline vascular type of unicentric Castleman disease (HV-UCD) was reported more than six decades ago. Since patients with HV-UCD are often asymptomatic and this condition is generally discovered incidentally on imaging tests, most of the previous reports were of mediastinal origin detected by chest radiography. In recent years, improved access to imaging modalities has provided new insights in the diagnosis of this condition. In this study, we reviewed the detailed clinical and pathological findings of 38 HV-UCD cases (20 males and 18 females, mean age: 42.8 years). The most common site involved was the abdominal cavity (34.2%), followed by mediastinum (23.7%) and retroperitoneum (15.8%). In the abdominal cavity, mesenteric origin was the most common. The mean size of masses was 4.8 cm. Pathologically, thick hyalinized collagen fibers surrounding large blood vessels and calcification were observed (81.6% and 23.7%, respectively). Multinucleated giant cells resembling Warthin–Finkeldey cell were also observed in occasional cases (23.7%). This is a unique paper that summarizes detailed clinical and pathological findings of a large series of a rare disease. The clinical information presented in this paper is more plausible than previous views and is useful for accurate diagnosis and understanding of the disease.
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Affiliation(s)
- Midori Filiz Nishimura
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan; (M.F.N.); (T.Y.)
| | - Yoshito Nishimura
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan;
- Department of Medicine, John A. Burns School of Medicine, University of Hawai’i, Honolulu, HI 96813, USA
| | - Asami Nishikori
- Division of Pathophysiology, Okayama University Graduate School of Health Sciences, Okayama 700-8558, Japan; (A.N.); (Y.M.); (K.M.)
| | - Yukina Maekawa
- Division of Pathophysiology, Okayama University Graduate School of Health Sciences, Okayama 700-8558, Japan; (A.N.); (Y.M.); (K.M.)
| | - Kanna Maehama
- Division of Pathophysiology, Okayama University Graduate School of Health Sciences, Okayama 700-8558, Japan; (A.N.); (Y.M.); (K.M.)
| | - Tadashi Yoshino
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan; (M.F.N.); (T.Y.)
| | - Yasuharu Sato
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 700-8558, Japan; (M.F.N.); (T.Y.)
- Division of Pathophysiology, Okayama University Graduate School of Health Sciences, Okayama 700-8558, Japan; (A.N.); (Y.M.); (K.M.)
- Correspondence: ; Tel.: +81-86-235-7150
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Sathishkumar D, Agrawal P, Baitule AM, Thomas M, Eapen A, Kumar S, George R. Paraneoplastic Autoimmune Multiorgan Syndrome: A Retrospective Study from a Tertiary Care Center in South India. Indian Dermatol Online J 2021; 12:572-576. [PMID: 34430462 PMCID: PMC8354390 DOI: 10.4103/idoj.idoj_640_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/09/2020] [Accepted: 12/20/2020] [Indexed: 11/23/2022] Open
Abstract
Background: Paraneoplastic autoimmune multiorgan syndrome (PAMS), first described as paraneoplastic pemphigus (PNP) is a heterogeneous autoimmune syndrome with a diverse spectrum of clinical and immunopathological features associated with an internal neoplasm. Materials and Methods: The details of the patients diagnosed with PAMS/PNP from an Indian tertiary center between January 2010 to December 2019 were retrieved from the hospital database. The clinical manifestations, histopathological features, immunofluorescence findings, and other relevant clinical details were obtained. Results: There were eight patients (4 males, 4 females) with PAMS, age ranging from 8 to 46 years (mean 31 years), of whom two were 8-year-old children. The mucocutaneous manifestations were polymorphic and all had recalcitrant oral mucosal involvement. The most common mucosal presentation was pemphigus-like (5/8), and the cutaneous presentation was lichen planus-like (5/8). Castleman's disease (5/8) was the commonest neoplasm followed by thymoma (2/8). Interface dermatitis was seen in all biopsies and three different patterns of direct immunofluorescence were seen, which were intercellular “fish-net” fluorescence in the epidermis (2/8), granular/linear deposition along the basement membrane (4/8) and a combination of both patterns (1/8). Indirect immunofluorescence done on rat bladder in 3 patients showed intercellular “fish-net” fluorescence. Desmoglein levels were not elevated in any of our patients. The follow-up period ranged from 1 to 112.5 months (mean, 23.6 months) with a mortality rate of 12.5%. Conclusion: In our study, Castleman's disease was the most common associated malignancy, and the mucocutaneous and histopathological findings were heterogeneous. Timely diagnosis and early intervention improved the outcome in our patients.
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Affiliation(s)
- Dharshini Sathishkumar
- Department of Dermatology, Venereology and Leprosy, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Poonam Agrawal
- Department of Dermatology, Venereology and Leprosy, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Amey Madhav Baitule
- Department of Pathology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Meera Thomas
- Department of Pathology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Anu Eapen
- Department of Radiology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Sathish Kumar
- Department of Paediatric Rheumatology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Renu George
- Department of Dermatology, Venereology and Leprosy, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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6
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Abstract
Haematological malignancies induce important alterations of the immune system, which account for the high frequency of autoimmune complications observed in patients. Cutaneous immune-mediated diseases associated with haematological malignancies encompass a heterogeneous group of dermatoses, including, among others, neutrophilic and eosinophilic dermatoses, autoantibody-mediated skin diseases, vasculitis and granulomatous dermatoses. Some of these diseases, such as paraneoplastic pemphigus, are associated with an increased risk of death; others, such as eosinophilic dermatoses of haematological malignancies, run a benign clinical course but portend a significant negative impairment on a patient’s quality of life. In rare cases, the skin eruption reflects immunological alterations associated with an unfavourable prognosis of the associated haematological disorder. Therapeutic management of immune-mediated skin diseases in patients with haematological malignancies is often challenging. Systemic corticosteroids and immunosuppressive drugs are considered frontline therapies but may considerably augment the risk of serious infections. Indeed, developing a specific targeted therapeutic approach is of crucial importance for this particularly fragile patient population. This review provides an up-to-date overview on the immune-mediated skin diseases most frequently encountered by patients with onco-haematological disorders, discussing new pathogenic advances and therapeutic options on the horizon.
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7
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Abstract
Originally described by Anhalt as paraneoplastic pemphigus in 1990, paraneoplastic autoimmune multiorgan syndrome (PAMS) is a potentially lethal blistering disease, characterized by polymorphous clinical features, including mucocutaneous erosions, blisters, lichenoid papules, and erythemas. Several autoantibodies have been detected in serum of PAMS patients, including antiplakins, anti-alpha-2-macroglobulin like 1, and antidesmogleins autoantibodies. The mortality rate of PAMS is up to 90%. This is due on the one hand to the poor response to treatments and on the other hand to the delay in the diagnosis and to the prognosis of the underlying neoplasia.
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Affiliation(s)
- Dario Didona
- Department of Dermatology and Allergology, Philipps University, Marburg, Germany -
| | | | - Pascal Joly
- Department of Dermatology, Rouen University Hospital and INSERM U905, Reference center for autoimmune bullous diseases, Normandie University, Rouen, France
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8
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Lepekhova AA, Teplyuk NP, Bolotova IM. Modern diagnostic methods of paraneoplastic pemphigus. VESTNIK DERMATOLOGII I VENEROLOGII 2019. [DOI: 10.25208/0042-4609-2019-95-5-7-16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Paraneoplastic pemphigus (PNP) is one of the least investigated and rare forms of bullous dermatoses, which comes from underlying neoplasm. The article presents a literature review of dermatologist`s longstanding international experience about etiology, pathogenesis, diagnostics and treatment of this disease. According to the research results of native and foreign authors systematization of modern diagnostic methods of PNP and detectable antigens was performed.Conflict of interest: the authors state that there is no potential conflict of interest requiring disclosure in this article.
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Affiliation(s)
- A. A. Lepekhova
- I. M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation
| | - N. P. Teplyuk
- I. M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation
| | - I. M. Bolotova
- Pirogov Russian National Research Medical University, Ministry of Health of the Russian Federation
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9
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Maruta CW, Miyamoto D, Aoki V, de Carvalho RGR, Cunha BM, Santi CG. Paraneoplastic pemphigus: a clinical, laboratorial, and therapeutic overview. An Bras Dermatol 2019; 94:388-398. [PMID: 31644609 PMCID: PMC7007015 DOI: 10.1590/abd1806-4841.20199165] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 06/17/2019] [Indexed: 12/27/2022] Open
Abstract
Paraneoplastic pemphigus is a rare and severe autoimmune blistering disease characterized by mucocutaneous lesions associated with benign and malignant neoplasms. Diagnostic criteria include the presence of chronic mucositis and polymorphic cutaneous lesions with occult or confirmed neoplasia; histopathological analysis exhibiting intraepidermal acantholysis, necrotic keratinocytes, and vacuolar interface dermatitis; direct immunofluorescence with intercellular deposits (IgG and C3) and at the basement membrane zone (IgG); indirect immunofluorescence with intercellular deposition of IgG (substrates: monkey esophagus and simple, columnar, and transitional epithelium); and, autoreactivity to desmogleins 1 and 3, desmocollins 1, 2, and 3, desmoplakins I and II, envoplakin, periplakin, epiplakin, plectin, BP230, and α-2-macroglobulin-like protein 1. Neoplasias frequently related to paraneoplastic pemphigus include chronic lymphocytic leukemia, non-Hodgkin lymphoma, carcinomas, Castleman disease, thymoma, and others. Currently, there is no standardized treatment for paraneoplastic pemphigus. Systemic corticosteroids, azathioprine, mycophenolate mofetil, cyclosporine, rituximab, cyclophosphamide, plasmapheresis, and intravenous immunoglobulin have been used, with variable outcomes. Reported survival rates in 1, 2, and 5 years are 49%, 41%, and 38%, respectively.
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Affiliation(s)
- Celina Wakisaka Maruta
- Department of Dermatology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Denise Miyamoto
- Department of Dermatology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Valeria Aoki
- Department of Dermatology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Breno Medeiros Cunha
- Department of Dermatology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Claudia Giuli Santi
- Department of Dermatology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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10
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DiSantis F, Hames N, Weiss L. A Teenager With Painful Oral and Genital Lesions. Clin Pediatr (Phila) 2019; 58:1034-1037. [PMID: 31113215 DOI: 10.1177/0009922819850478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Francesca DiSantis
- 1 Philadelphia College of Osteopathic Medicine Georgia Campus, Suwanee, GA, USA
| | - Nicole Hames
- 2 Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,3 Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Lindsay Weiss
- 2 Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,3 Children's Healthcare of Atlanta, Atlanta, GA, USA
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11
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Han SP, Fu LS, Chen LJ. Masked pemphigus among pediatric patients with Castleman’s disease. Int J Rheum Dis 2018; 22:121-131. [DOI: 10.1111/1756-185x.13407] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 06/05/2018] [Accepted: 09/14/2018] [Indexed: 01/18/2023]
Affiliation(s)
- Shu-Ping Han
- Department of Pediatrics; Taichung Veterans General Hospital; Taichung Taiwan
| | - Lin-Shien Fu
- Department of Pediatrics; Taichung Veterans General Hospital; Taichung Taiwan
- Department of Pediatrics; National Yang-Ming University; Taipei Taiwan
| | - Lu-Jen Chen
- Department of Pathology; Taichung Veterans General Hospital; Taichung Taiwan
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12
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Paraneoplastic Pemphigus: Insight into the Autoimmune Pathogenesis, Clinical Features and Therapy. Int J Mol Sci 2017; 18:ijms18122532. [PMID: 29186863 PMCID: PMC5751135 DOI: 10.3390/ijms18122532] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 11/09/2017] [Accepted: 11/24/2017] [Indexed: 11/17/2022] Open
Abstract
Paraneoplastic pemphigus is a rare autoimmune skin disease that is always associated with a neoplasm. Usually, oral, skin, and mucosal lesions are the earliest manifestations shown by paraneoplastic pemphigus patients. The pathogenesis of paraneoplastic pemphigus is not yet completely understood, although some immunological aspects have been recently clarified. Because of its rarity, several diagnostic criteria have been proposed. Besides, several diagnostic procedures have been used for the diagnosis, including indirect immunofluorescence, direct immunofluorescence, and ELISA. We reviewed the most recent literature, searching on PubMed "paraneoplastic pemphigus". We included also papers in French, German, and Spanish. We found 613 papers for "paraneoplastic pemphigus". Among them, 169 were review papers. Because of its varying clinical features, paraneoplastic pemphigus still represents a challenge for clinicians. Furthermore, diagnosis and management of paraneoplastic pemphigus requires close collaboration between physicians, including dermatologist, oncologist, and otorhinolaryngologist.
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13
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Lee SY, Kim JH, Cho DH. High-dose-rate intraluminal brachytherapy for paraneoplastic autoimmune multiorgan syndrome. Exp Ther Med 2016; 12:1435-1439. [PMID: 27602070 PMCID: PMC4998192 DOI: 10.3892/etm.2016.3458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 05/26/2016] [Indexed: 12/22/2022] Open
Abstract
Paraneoplastic autoimmune multiorgan syndrome (PAMS), also known as paraneoplasic pemphigus, involves the skin, internal organs and mucosa. PAMS-associated mortality may occur as a result of autoantibody formation against internal tumors and their infiltration into organs other than the skin lesions that characterize PAMS. The most common symptoms of PAMS include pain associated with continuous oral ulceration and resistance to pharmacological treatment. The present study reports the case of a 42-year-old female patient who was admitted with an 8-month history of erosive skin lesions within the trunk region, oral mucosa and vaginal mucosa. The patient was diagnosed with PAMS based on computed tomography scans and histological analyses of the lesions. The lymphoid hyperplasia in the retroperitoneum and lesions in the vaginal mucosa and trunk area were improved following pharmacological treatment and resection of the lymph node showing hyperplasia. However, the oral lesion was treated with intraluminal brachytherapy due to its resistance to long-term pharmacological treatment. The majority of the lesions were improved following treatment, in the absence of any severe side effects. In addition, neither worsening nor progression of the oral lesion was observed during the 4-year follow-up period.
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Affiliation(s)
- Sun-Young Lee
- Department of Radiation Oncology, Institute for Medical Sciences, Chonbuk National University Medical School, Jeonju, Jeollabuk-do 561-712, Republic of Korea; Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute, Chonbuk National University Hospital, Jeonju, Jeollabuk-do 561-712, Republic of Korea
| | - Jong-Hyun Kim
- Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute, Chonbuk National University Hospital, Jeonju, Jeollabuk-do 561-712, Republic of Korea; Department of Obstetrics and Gynecology, Chonbuk National University Hospital, Jeonju, Jeollabuk-do 561-712, Republic of Korea
| | - Dong-Hyu Cho
- Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute, Chonbuk National University Hospital, Jeonju, Jeollabuk-do 561-712, Republic of Korea; Department of Obstetrics and Gynecology, Chonbuk National University Hospital, Jeonju, Jeollabuk-do 561-712, Republic of Korea
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14
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Halpert E, Figueroa JL, Rojas A, Ortiz CI, Chaparro D, Galindo M, Lammoglia JJ, Rumie C, Olmos C. Inflammatory myofibroblastic tumor presenting as paraneoplastic pemphigus in a 7-year-old girl. JAAD Case Rep 2016; 2:37-40. [PMID: 27051823 PMCID: PMC4809448 DOI: 10.1016/j.jdcr.2015.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Evelyne Halpert
- Department of Dermatology, Fundación Santafe de Bogotá, Bogotá, Colombia
| | | | - Armando Rojas
- Department of Pediatric Surgery, Fundación Santafe de Bogotá, Bogotá, Colombia
| | - Clara Ines Ortiz
- Department of Dermatology, Fundación Santafe de Bogotá, Bogotá, Colombia
| | - Daniela Chaparro
- Universidad del Rosario, Bogotá, Colombia
- Correspondence to: Daniela Chaparro, MD, Clinical Epidemiology Specialist, Av 9 # 116 - 20. Cons 730. Bogotá, Colombia.Clinical EpidemiologistUniversidad del RosarioBogotáColombia
| | - Marcela Galindo
- Department of Pediatrics, Fundación Santafe de Bogotá, Bogotá, Colombia
| | | | - Carolina Rumie
- Department of Radiology, Fundación Santafe de Bogotá, Bogotá, Colombia
| | - Carlos Olmos
- Department of Pediatrics, Fundación Santafe de Bogotá, Bogotá, Colombia
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15
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Abstract
Bullous diseases may be rare; however, this does not preclude the clinician from being familiar with their manifestations and treatment. After ruling out infection, genetically inherited blistering diseases are more likely to be the cause of blistering or erosions in the neonatal period, whereas immunobullous diseases are more common in adults. Published literature on immunobullous disorders reflects information gleaned from case reports and open-label case series; prospective studies and evidence-based treatments are limited. Although there may be overlapping clinical features, significant clinical differences exist between adults and children. Evidence-based treatment guidelines are limited, and information from the adult literature cannot be readily generalized to the pediatric population. This paper reviews the approach to blistering conditions and the differences among bullous pemphigoid, linear immunoglobulin A disease, dermatitis herpetiformis, pemphigus foliaceus, pemphigus vulgaris, and paraneoplastic pemphigus in adult versus pediatric patients.
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Affiliation(s)
- Kalyani Marathe
- Department of Dermatology, Columbia University College of Physicians and Surgeons, 161 Fort Washington Avenue, 12th Floor, New York, NY, 10032, USA
| | - Jun Lu
- Department of Dermatology, University of Connecticut School of Medicine, 21 South Road, Farmington, CT, 06032, USA
| | - Kimberly D Morel
- Departments of Dermatology & Pediatrics, Columbia University College of Physicians and Surgeons, 161 Fort Washington Avenue, 12th Floor, New York, NY, 10032, USA.
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16
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Huang LC, Wong JR, Alonso-Llamazares J, Nousari CH, Perez VL, Amescua G, Karp CL, Galor A. Pseudopemphigoid as caused by topical drugs and pemphigus disease. World J Ophthalmol 2015; 5:1-15. [DOI: 10.5318/wjo.v5.i1.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 09/19/2014] [Accepted: 11/10/2014] [Indexed: 02/05/2023] Open
Abstract
Pseudopemphigoid can cause a chronic cicatricial conjunctivitis that is clinically identical to the manifestations seen in mucous membrane pemphigoid, a disorder with a common clinical phenotype and multiple autoimmune links. For the purpose of this review, we will describe pseudopemphigoid as caused by topical drugs, the most common etiology with ocular manifestations, and as caused by the pemphigus disease, a more rare etiology. Specifically, we will discuss the ophthalmological features of drug-induced cicatricial conjunctivitis, pemphigus vulgaris, and paraneoplastic pemphigus. Other etiologies of pseudopemphigoid exist that will not be described in this review including autoimmune or inflammatory conditions such as lichen planus, sarcoidosis, granulomatosis with polyangiitis (Wegener’s granulomatosis), erythema multiforme (minor, major, and Stevens-Johnson syndrome), bullous pemphigoid, skin-dominated linear IgA bullous dermatosis, and skin-dominated epidermolysis bullosa acquisita. Prompt diagnosis of the underlying etiology in pseudopemphigoid is paramount to the patient’s outcome as certain diseases are associated with a more severe clinical course, increased ocular involvement, and differential response to treatment. A complete history and ocular examination may find early cicatricial changes in the conjunctiva that are important to note and evaluate to avoid progression to more severe disease manifestations. When such cicatricial changes are noted, proper diagnostic techniques are needed to help elucidate a diagnosis. Lastly, collaboration between ophthalmologists and subspecialists such as dermatologists, pathologists, immunologists, and others involved in the care of the patient is needed to ensure optimal management of disease.
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Lehman VT, Barrick BJ, Pittelkow MR, Peller PJ, Camilleri MJ, Lehman JS. Diagnostic imaging in paraneoplastic autoimmune multiorgan syndrome: retrospective single site study and literature review of 225 patients. Int J Dermatol 2014; 54:424-37. [DOI: 10.1111/ijd.12603] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Vezzoli P, Berti E, Marzano AV. Rationale and efficacy for the use of rituximab in paraneoplastic pemphigus. Expert Rev Clin Immunol 2014; 4:351-63. [DOI: 10.1586/1744666x.4.3.351] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Choh NA, Qayoom S, Shaheen F, Malik RA, Rabbani I, Gojwari T. Retroperitoneal Castlemans disease associated with paraneoplastic pemphigus. Hematol Oncol Stem Cell Ther 2013; 7:93-6. [PMID: 24333134 DOI: 10.1016/j.hemonc.2013.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Revised: 10/28/2013] [Accepted: 11/18/2013] [Indexed: 11/26/2022] Open
Abstract
Paraneoplastic pemphigus is a rare dermatologic condition that can occur as a paraneoplastic manifestation of lymphoproliferative disorders, visceral malignancies, Castleman disease and thymomas. In a pediatric age group paraneoplastic pemphigus has a striking association with Castleman disease and has a particularly poor prognosis in this age group. We describe a case of paraneoplastic pemphigus associated with retroperitoneal hyaline vascular variant of Castleman disease with a fatal outcome despite aggressive management.
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Affiliation(s)
- Naseer A Choh
- Dept of Radiodiagnosis, Sheri Kashmir Institute of Medical Sciences, Srinagar, India.
| | - Seema Qayoom
- Dept of Dermatology, Sheri Kashmir Institute of Medical Sciences, Srinagar, India
| | - Feroze Shaheen
- Dept of Radiodiagnosis, Sheri Kashmir Institute of Medical Sciences, Srinagar, India
| | - Rais A Malik
- Dept of Pathology, Sheri Kashmir Institute of Medical Sciences, Srinagar, India
| | - Irfan Rabbani
- Dept of Radiodiagnosis, Sheri Kashmir Institute of Medical Sciences, Srinagar, India
| | - Tariq Gojwari
- Dept of Radiodiagnosis, Sheri Kashmir Institute of Medical Sciences, Srinagar, India
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Paraneoplastic pemphigus: a paraneoplastic autoimmune multiorgan syndrome or autoimmune multiorganopathy? Case Rep Dermatol Med 2012; 2012:207126. [PMID: 23316398 PMCID: PMC3535815 DOI: 10.1155/2012/207126] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 12/03/2012] [Indexed: 12/13/2022] Open
Abstract
Paraneoplastic pemphigus (PNP), a clinically and immunopathologically distinct mucocutaneous blistering dermatosis, is a severe form of autoimmune multiorgan syndrome generally associated with poor therapeutic outcome and high mortality. This IgG-mediated disease is initiated by an obvious or occult lymphoproliferative disorder in most cases. Clinically severe mucositis, and polymorphic blistering skin eruptions, and histologically acantholysis, keratinocyte necrosis and interface dermatitis are its hallmark features. A 58-year-old female presented with recurrent, severe, recalcitrant stomatitis and widespread erosions/blistering lesions of one-year duration. Treatment with repeated courses of systemic corticosteroids at a peripheral center would provide temporary relief. She also had fever, productive cough, odynophagia and poor oral intake, herpes zoster ophthalmicus, pain in the abdomen, and watery diarrhea. An array of investigations revealed chronic lymphocytic leukemia (CLL), mediastinal and para-aortic lymphadenopathy, bronchiolitis obliterans, and vertebral osteoporosis/fractures. With the diagnosis of CLL-associated PNP she was managed with dexamethasone-cyclophosphamide pulse (DCP) therapy for 3 cycles initially, followed by COP regimen (cyclophosphamide, vincristine, and prednisolone) for 5 cycles. Remission is being maintained with chlorambucil and prednisolone pulse therapy once in 3 weeks with complete resolution of skin lesions and adequate control of CLL.
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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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Fedorchuk OG, Pyaskovskaya OM, Skivka LM, Gorbik GV, Trompak OO, Solyanik GI. Paraneoplastic syndrome in mice bearing high-angiogenic variant of Lewis lung carcinoma: Relations with tumor derived VEGF. Cytokine 2012; 57:81-8. [DOI: 10.1016/j.cyto.2011.10.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Revised: 10/27/2011] [Accepted: 10/31/2011] [Indexed: 01/22/2023]
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Jing L, Shan Z, Yongchu H, Xixue C, Xuejun Z. Successful treatment of a paraneoplastic pemphigus in a teenager using plasmapheresis, corticosteroids and tumour resection. Clin Exp Dermatol 2011; 36:752-4. [PMID: 21933232 DOI: 10.1111/j.1365-2230.2011.04081.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Paraneoplastic pemphigus (PNP) is a severe autoimmune blistering disease. Bronchiolitis obliterans (BO) is a common complication of PNP, is the major cause of death. PNP is rarely seen before the age of 18 years, and the prognosis is poor because of BO. We report a 16-year-old girl with the typical findings of PNP associated with Castleman's tumour. She was treated with tumour resection in combination with plasmapheresis and corticosteroids. Fifteen months after the operation, the patient had recovered without the development of BO.
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Affiliation(s)
- L Jing
- Department of Dermatology, Peking University First Hospital, Beijing, China
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Czernik A, Camilleri M, Pittelkow MR, Grando SA. Paraneoplastic autoimmune multiorgan syndrome: 20 years after. Int J Dermatol 2011; 50:905-14. [DOI: 10.1111/j.1365-4632.2011.04868.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cervini A, Tosi V, Kim S, Bocian M, Chantada G, Nousari C, Carballo O, Pierini A. Pénfigo paraneoplásico/síndrome multiorgánico autoinmune paraneoplásico. Presentación de dos casos en la edad infantil. Revisión de la literatura. ACTAS DERMO-SIFILIOGRAFICAS 2010. [DOI: 10.1016/j.ad.2010.06.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Castellarin P, Pozzato G, Tirelli G, Di Lenarda R, Biasotto M. Oral lesions and lymphoproliferative disorders. JOURNAL OF ONCOLOGY 2010; 2010:202305. [PMID: 20871659 PMCID: PMC2939410 DOI: 10.1155/2010/202305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Revised: 07/13/2010] [Accepted: 07/26/2010] [Indexed: 11/17/2022]
Abstract
Lymphoproliferative disorders are heterogeneous malignancy characterized by the expansion of a lymphoid clone more or less differentiated. At the level of the oral cavity, the lymphoproliferative disorder can occur in various ways, most commonly as lymphoid lesions with extranodal externalization, but sometimes, oral lesions may represent a localization of a disease spread. With regard to the primary localizations of lymphoproliferative disorders, a careful examination of the head and neck, oral, and oropharyngeal area is necessary in order to identify suspicious lesions, and their early detection results in a better prognosis for the patient. Numerous complications have been described and frequently found at oral level, due to pathology or different therapeutic strategies. These complications require precise diagnosis and measures to oral health care. In all this, oral pathologists, as well as dental practitioners, have a central role in the treatment and long-term monitoring of these patients.
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Affiliation(s)
- P. Castellarin
- Department of Dental Science, University of Trieste, 34127 Trieste, Italy
| | - G. Pozzato
- Department of Haematology, University of Trieste, 34142 Trieste, Italy
| | - G. Tirelli
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Trieste, 34127 Trieste, Italy
| | - R. Di Lenarda
- Department of Dental Science, University of Trieste, 34127 Trieste, Italy
| | - M. Biasotto
- Department of Dental Science, University of Trieste, 34127 Trieste, Italy
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Cervini A, Tosi V, Kim S, Bocian M, Chantada G, Nousari C, Carballo O, Pierini A. Paraneoplastic Pemphigus or Paraneoplastic Autoimmune Multiorgan Syndrome. Report of 2 Cases in Children and a Review of the Literature. ACTAS DERMO-SIFILIOGRAFICAS 2010. [DOI: 10.1016/s1578-2190(10)70735-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Billet SE, Grando SA, Pittelkow MR. Paraneoplastic autoimmune multiorgan syndrome: Review of the literature and support for a cytotoxic role in pathogenesis. Autoimmunity 2009; 39:617-30. [PMID: 17101506 DOI: 10.1080/08916930600972099] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Paraneoplastic autoimmune multiorgan syndrome (PAMS), first described as paraneoplastic pemphigus in 1990, is an autoimmune blistering disease associated with neoplasia. Patients with this rare disorder have severe blistering and painful erosions of the oral cavity and various other cutaneous findings ranging from classic pemphigus vulgaris-like erosions to targetoid lesions resembling erythema multiforme and papular to more confluent lichenoid eruptions. This syndrome involves multiple organ systems, and its high rate of mortality often stems from constrictive bronchiolitis obliterans. The histologic findings are as diverse as the clinical presentation, often making diagnosis difficult initially. Immunodermatologic and serologic laboratory findings typically establish the diagnosis. These results can be confirmed with immunoprecipitation profiling of specific molecular weight protein markers. The proposed pathogenesis of PAMS continues to evolve, and recent reports implicate the involvement of cell-mediated, cytotoxic immunity, in addition to humoral autoantibodies. This review characterizes and summarizes the clinical, pathologic, and immunohistologic features of PAMS and outlines the possible role of cytotoxic T lymphocytes in the pathogenesis of this syndrome.
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Affiliation(s)
- Sara E Billet
- Department of Dermatology, Mayo Clinic, Rochester, MN 55905, USA
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Rodríguez Carrasco J, Fernández Marín CE, López Peña C, Muñoz Hoyos A, Cámara Pulido M. [Castleman's disease: presentation of an atypical case]. An Pediatr (Barc) 2009; 70:61-4. [PMID: 19174122 DOI: 10.1016/j.anpedi.2008.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2008] [Accepted: 09/04/2008] [Indexed: 11/18/2022] Open
Abstract
Castleman's disease is an unknown etiology lymphoproliferative disorder rare in childhood (only 100 cases described in the literature, 7 of them in Spain). It usually appears in young adults, with no gender-related differences. There are two clinical forms of the disease: the localized variant, the more frequent type, usually presented as a solitary mass (generally in the mediastinum) and asymptomatic at the time of diagnosis, and the multicentric variant, less frequent and usually associated with systemic symptoms and a more aggressive clinical evolution. The diagnosis is confirmed based on the histopathological study. There are two histological variants: the hyaline-vascular type, which usually appears as a localised variant, and the plasma-cell type, which usually appears as multicentric variant and has a worse prognosis. While the best treatment for the localised variant is surgical resection, which is curative, for the multicentric variant many therapeutic strategies have been used without real success. In the present article we report a new case of this disease in a 3-year-old girl with the localised form, who remains asymptomatic after two years of follow-up, and a review of the available literature. This disease should be included in the differential diagnosis of the lymphoproliferative disorders.
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Affiliation(s)
- J Rodríguez Carrasco
- Unidad de Gestión Clínica de Pediatría, Hospital Universitario San Cecilio, Granada, España.
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Carr DR, Houshmand E, Heffernan MP. Approach to the acute, generalized, blistering patient. ACTA ACUST UNITED AC 2008; 26:139-46. [PMID: 18070680 DOI: 10.1016/j.sder.2007.09.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This article discusses the approach to the acute, generalized, blistering patient from the perspective of the dermatologic consultant. Initially, a case is presented, followed by a discussion of the relevant evaluation, differential diagnosis, and treatment options.
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Affiliation(s)
- David R Carr
- Division of Dermatology, Wright State University, Dayton, OH 45408-1445, USA
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Wang SH, Chu CY, Chen HH, Chang YL, Chen KY, Chiu HC. Paraneoplastic Pemphigus and Bronchiolitis Obliterans in a Patient with Splenic B-cell Lymphoma. J Formos Med Assoc 2007; 106:768-73. [PMID: 17908666 DOI: 10.1016/s0929-6646(08)60038-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Paraneoplastic pemphigus (PNP), also called paraneoplastic autoimmune multiorgan syndrome, is a rare disorder associated with underlying neoplasia. The common underlying neoplasms include non-Hodgkins lymphoma, chronic lymphocytic leukemia, and Castlemans disease. Though B-cell lymphoma is the most common underlying malignancy, only one case associated with splenic B-cell lymphoma has been recognized. The prognosis of PNP is very poor, and PNP-associated bronchiolitis obliterans (BO) is not uncommon. Herein, we report a 44-year-old woman who initially presented with multiple oral ulcers, conjunctivitis, and numerous cutaneous blisters. Serial workup established the diagnosis of PNP and revealed an underlying splenic B-cell lymphoma. Although the mucocutaneous lesions gradually healed after splenectomy and chemotherapy, deteriorating respiratory function developed 7 months later with pathologically proven BO. She finally succumbed to respiratory failure 12 months after presentation despite intensive respiratory care.
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Affiliation(s)
- Shiou-Han Wang
- Department of Dermatology, National Taiwan University Hospital, Taipei, Taiwan
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Abstract
Paraneoplastic pemphigus (PNP) is a life-threatening autoimmune blistering skin disease. Clinically, it is characterized by severe mucosal erosions and various cutaneous lesions associated with lymphoproliferative neoplasmas. Suprabasal acantholysis and clefts with scattered necrotic keratinocytes are the unique histopathological features. PNP patient sera recognize multiple antigens, which have been identified as the plakin protein family that includes desmoplakin, bullous pemphigoid antigen I (BPAG1), envoplakin and periplakin, and desmogleins 1 and 3. Castleman's tumor, non-Hodgkin's lymphoma, thymoma, follicular dendritic cell sarcoma and chronic lymphocytic leukemia are the commonly associated neoplasmas in PNP. We have also demonstrated that the autoantibodies reacting to epidermal proteins are directly produced by the cells in the associated tumors. Bronchiolitis obliterans is frequently found in PNP and may cause respiratory failure and death. In our experience, the early detection and removal of the tumor and i.v. administration of immunoglobulin are critical for the treatment of PNP.
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Affiliation(s)
- Xuejun Zhu
- Department of Dermatology, Peking University First Hospital, Beijing, China.
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