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Onodera H, Mihm MC, Yoshida A, Akasaka T. Drug-Induced Linear IgA Bullous Dermatosis. J Dermatol 2014; 32:759-64. [PMID: 16361722 DOI: 10.1111/j.1346-8138.2005.tb00839.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2005] [Accepted: 04/27/2005] [Indexed: 11/30/2022]
Abstract
We report the case of a 69-year-old Japanese woman with multiple blistering lesions covering almost her whole body. Linear IgA and C3 depositions were seen at the basement membrane zone on direct immunofluorescence (IF). Linear IgA bullous dermatosis (LABD) is one of the autoimmune diseases resulting in subepidermal blisters. It is clinically similar to bullous pemphigoid and IF is required to distinguish the two diseases. In this case, the blistering lesions appeared after vancomycin treatment. This drug was strongly suspected as a cause of LABD in light of the clinical course of the patient even though a drug-lymphocyte stimulating test was negative. Among the various implicated causative drugs, vancomycin is the most commonly associated with LABD.
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Affiliation(s)
- Hanae Onodera
- Dermatopathology Unit, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Warren 827, Boston, MA 02114, USA
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Fortuna G, Salas-Alanis JC, Guidetti E, Marinkovich MP. A critical reappraisal of the current data on drug-induced linear immunoglobulin A bullous dermatosis: A real and separate nosological entity? J Am Acad Dermatol 2012; 66:988-94. [DOI: 10.1016/j.jaad.2011.09.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Revised: 09/08/2011] [Accepted: 09/20/2011] [Indexed: 01/22/2023]
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Polder K, Wang C, Duvic M, Diwan AH, Parks D, Jankov A, Walker PL, Tong AT, Bull J, Dang NH. Toxic epidermal necrolysis associated with denileukin diftitox (DAB389IL-2) administration in a patient with follicular large cell lymphoma. Leuk Lymphoma 2006; 46:1807-11. [PMID: 16263585 DOI: 10.1080/10428190500233764] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Denileukin diftitox (DAB(389)IL-2 or Ontak) is a synthetic fusion protein with demonstrated efficacy in a number of lymphoproliferative disorders, including non-Hodgkin's lymphoma. We report the case of a 45-year-old man with progressive follicular large cell lymphoma following an autologous stem cell transplant treated with denileukin diftitox who developed a fatal skin rash associated with extensive erythema, edema and large bullae involving his entire body. The clinical features and pathology were compatible with toxic epidermal necrolysis. This is the first reported case of toxic epidermal necrolysis in the literature associated with denileukin diftitox.
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Affiliation(s)
- Kristel Polder
- Memorial Hermann Hospital, University of Texas Health Science Center at Houston, TX, USA
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Armstrong AW, Fazeli A, Yeh SW, Mackool BT, Liu V. Vancomycin-induced linear IgA disease manifesting as bullous erythema multiforme. J Cutan Pathol 2004; 31:393-7. [PMID: 15059226 DOI: 10.1111/j.0303-6987.2004.00190.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Vancomycin-induced linear immunoglobulin A (IgA) disease, an autoimmune, blistering disease in response to vancomycin administration, is characterized by a subepidermal, vesiculobullous eruption and linear IgA deposition along the basement membrane zone on direct immunofluorescence. CASE REPORT We report the case of an 81-year-old man treated with vancomycin who developed diffuse erythema multiforme and tense bullae involving the palmoplantar surfaces. Discontinuation of vancomycin therapy resulted in complete resolution of this patient's cutaneous eruption. RESULTS Biopsy of a representative skin lesion demonstrated lichenoid interface dermatitis with focal subepidermal clefting, dyskeratosis, and prominent eosinophils. Direct immunofluorescence showed linear basement membrane staining with immunoreactants to IgA; indirect immunofluorescence demonstrated the presence of circulating IgG antibodies binding in an intercellular pattern. Immunoprecipitation studies using the patient's serum revealed 210, 130, and 83 kDa target antigens. CONCLUSIONS Presenting with an initial clinical picture suggestive of bullous erythema multiforme, this patient's subsequent clinical course and direct immunofluorescence confirm the diagnosis of linear IgA bullous disease (LABD). His indirect immunofluorescence findings and immunoprecipitation results suggest that circulating non-IgA antibodies may represent a newly recognized immunopathologic feature of vancomycin-induced linear IgA disease, underscoring the variable and unpredictable manifestations of this drug-induced cutaneous disease.
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Affiliation(s)
- April Wang Armstrong
- Pasteur/Doris Duke Clinical Research Fellowship, Harvard Medical School, Boston, MA, USA.
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Joshi S, Scott G, Looney RJ. A successful challenge in a patient with vancomycin-induced linear IgA dermatosis. Ann Allergy Asthma Immunol 2004; 93:101-3. [PMID: 15281479 DOI: 10.1016/s1081-1206(10)61454-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Linear IgA bullous dermatosis (LABD), a subepidermal, blistering skin disease, is generally believed to be idiopathic. It has been reported in association with multiple medications, including vancomycin. In each case, complete clearance of the skin lesions occurred with discontinued use of the drug. A subsequent rechallenge reproduced the eruption within hours to days. OBJECTIVE To present a patient with vancomycin-associated LABD who underwent a successful challenge with the antibiotic 4 years after the initial reaction. METHODS The patient developed blistering lesions over her trunk and extremities 10 days after the initiation of vancomycin for sepsis. A biopsy specimen of a skin eruption was consistent with linear IgA dermatosis. Following discontinued use of the drug, her skin lesions resolved. Four years later, she required vancomycin for osteomyelitis. RESULTS The patient underwent a vancomycin-graded challenge of 5 doses over 5 days. On day 1, she received 10 mg, and this was increased in a semilog fashion to 1,000 mg on day 5. She had no recurrence of her skin lesions. CONCLUSIONS This is the first case, to our knowledge, to show a successful rechallenge in a patient with drug-associated LABD. Since the patient did not have a reaction to the challenge, it is possible that the IgA antibodies responsible for drug-induced LABD are only present transiently and diminish over time.
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Affiliation(s)
- Sunil Joshi
- Department of Allergy-Immunology-Rheumatology, University of Rochester Medical Center, Rochester, New York 14642, USA.
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Tran D, Kossard S, Shumack S. Phenytoin-induced linear IgA dermatosis mimicking toxic epidermal necrolysis. Australas J Dermatol 2004; 44:284-6. [PMID: 14616498 DOI: 10.1046/j.1440-0960.2003.00011.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 60-year-old woman developed a severe widespread blistering eruption that also involved the palms and soles, but spared the mucosae, approximately 7 days after starting phenytoin. Phenytoin was commenced postoperatively after a craniotomy resection of a glioblastoma multiforme. The clinical features resembled that seen in toxic epidermal necrolysis. However, the patient was systemically well and the histology and immunofluorescence revealed linear IgA dermatosis. The skin lesions began to slowly heal 2 weeks after discontinuation of the phenytoin.
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Affiliation(s)
- Diana Tran
- Royal North Shore Hospital St Leonards, New South Wales, Australia
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Salmhofer W, Soyer HP, Wolf P, Födinger D, Hödl S, Kerl H. UV light–induced linear IgA dermatosis. J Am Acad Dermatol 2004; 50:109-15. [PMID: 14699378 DOI: 10.1016/s0190-9622(03)02120-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Various exogenous factors (eg, drugs, dietary antigens, trauma, infections, radiographs, and UV radiation) are known to induce or aggravate skin diseases. UV radiation in particular is known to induce or aggravate the autoimmune bullous diseases of pemphigus foliaceus, pemphigus vulgaris, and bullous pemphigoid. Its role in linear IgA dermatosis, however, is not well recognized. We report the second case of linear IgA dermatosis induced by intense sun exposure in which blistering was induced by UVA radiation. Furthermore, a review of the literature on photoinduced autoimmune bullous diseases and the wavelengths responsible for the induction of blistering is presented and several proposed mechanisms of action for the blister induction, including release or unmasking of antigens, promotion of antibody fixation by UV radiation, and launching of an inflammatory process, are discussed. We conclude that linear IgA dermatosis should be added to the list of autoimmune bullous diseases induced and/or aggravated by UV radiation.
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Delbaldo C, Chen M, Friedli A, Prins C, Desmeules J, Saurat JH, Woodley DT, Borradori L. Drug-induced epidermolysis bullosa acquisita with antibodies to type VII collagen. J Am Acad Dermatol 2002; 46:S161-4. [PMID: 12004302 DOI: 10.1067/mjd.2002.107774] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We describe a 73-year-old patient who had a subepidermal bullous eruption develop after a course of antibiotics, including vancomycin. The patient had deposits of IgA and IgG in the cutaneous basement membrane zone that were located on the dermal side of 1 M NaCl-treated autologous skin. By an enzyme-linked immunosorbent assay, the patient was found to have circulating IgG antibodies directed against type VII collagen, the target antigen of epidermolysis bullosa acquisita. Our observation expands the spectrum of immune-mediated subepidermal bullous skin eruptions precipitated by drugs and lends support to the idea that a subset of these cases represents an unusual variant of drug-triggered epidermolysis bullosa acquisita.
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Affiliation(s)
- Catherine Delbaldo
- Department of Internal Medicine, University Hospital, Geneva, Switzerland
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Palmer RA, Ogg G, Allen J, Banerjee A, Ryatt KS, Ratnavel R, Wojnarowska F. Vancomycin-induced linear IgA disease with autoantibodies to BP180 and LAD285. Br J Dermatol 2001; 145:816-20. [PMID: 11736908 DOI: 10.1046/j.1365-2133.2001.04492.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Linear IgA disease (LAD) is an acquired autoimmune subepidermal bullous disease characterized by the linear deposition of IgA at the basement membrane zone. A minority of cases are induced by drugs, of which the most frequently implicated is vancomycin. The target antigens in idiopathic LAD are heterogeneous, but have not previously been reported in vancomycin-induced LAD. We report three cases, and in two of these we investigated the target antigens. In both we identified IgA antibodies to LAD285 and IgA and IgG antibodies (dual response) to BP180.
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Affiliation(s)
- R A Palmer
- Department of Dermatology, Royal South Hants Hospital, Southampton SO14 OYG, UK.
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Affiliation(s)
- S V Guide
- Department of Dermatology, Stanford University School of Medicine, (M.P.M.), Stanford, California, USA
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del Pozo J, Martínez W, Yebra-Pimentel MT, Almagro M, Peña-Penabad C, Fonseca E. Linear immunoglobulin A bullous dermatosis induced by gemcitabine. Ann Pharmacother 2001; 35:891-3. [PMID: 11485141 DOI: 10.1345/aph.10268] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To report a case of linear immunoglobulin (Ig) A bullous dermatosis (LABD) induced by gemcitabine. CASE SUMMARY A 59-year-old man was diagnosed with squamous-cell carcinoma of the lung in T4N2M0 stage and treated with cisplatin, vinorelbine, and gemcitabine. Twenty-four hours after the administration of gemcitabine, a symmetric, bullous, herpetiform eruption appeared on his trunk and upper limbs. Histopathologic examination and direct immunofluorescence test were consistent with IgA bullous dermatosis. Cutaneous lesions resolved two weeks after the drug was withdrawn and topical steroid treatment was instituted. DISCUSSION Drug-induced LABD is a variant of classic or idiopathic LABD. Vancomycin is the most frequently implicated drug, but other agents have been reported to cause LABD. According to the Naranjo probability scale, the relationship of gemcitabine treatment with cutaneous eruption in our patient is possible. CONCLUSIONS We report the first case of gemcitabine-induced LABD. Clinicians should monitor patients receiving this drug for signs of LABD.
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Affiliation(s)
- J del Pozo
- Department of Dermatology, Hospital Juan Canalejo, La Coruña, Spain.
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Bouldin MB, Clowers-Webb HE, Davis JL, McEvoy MT, Davis MD. Naproxen-associated linear IgA bullous dermatosis: case report and review. Mayo Clin Proc 2000; 75:967-70. [PMID: 10994833 DOI: 10.4065/75.9.967] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Linear IgA bullous dermatosis (LABD) is an acquired autoimmune subepidermal blistering disorder in which linear deposits of IgA are found along the basement membrane. Idiopathic, systemic disorder-related, and drug-induced forms of LABD have been described. Drug-induced LABD occurs in association with drug administration and resolves when the offending agent is discontinued. Other forms of LABD assume a more chronic course. The nonsteroidal anti-inflammatory drugs piroxicam and diclofenac have been previously reported to induce LABD. To our knowledge, this article describes the first documented case of LABD associated with naproxen administration, which resolved after discontinuation of the drug.
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Affiliation(s)
- M B Bouldin
- Department of Dermatology, Mayo Clinic, Rochester, Minn 55905, USA
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Klein PA, Callen JP. Drug-induced linear IgA bullous dermatosis after vancomycin discontinuance in a patient with renal insufficiency. J Am Acad Dermatol 2000; 42:316-23. [PMID: 10640923 DOI: 10.1016/s0190-9622(00)90102-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Linear IgA bullous dermatosis (LABD) is an autoimmune, subepidermal, vesiculobullous disease that has been commonly associated with the use of vancomycin hydrochloride. Lesions typically appear during vancomycin therapy, 24 hours to 15 days after the first dose. A 65-year-old white man with renal insufficiency developed pruritic, tense bullae on the right chest, right medial arm, right flank, abdomen, and right upper thigh 14 days after his last dose of vancomycin. Histopathologic examination and immunofluorescence studies were diagnostic of LABD. Vancomycin-related LABD may appear as long as 2 weeks after the drug is discontinued.
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Affiliation(s)
- P A Klein
- Division of Dermatology, Department of Medicine, University of Louisville, Kentucky, USA
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Affiliation(s)
- C A Egan
- Medicine Service, Section of Dermatology, Salt Lake City Veterans Affairs Medical Center, Utah, USA
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Cerottini JP, Ricci C, Guggisberg D, Panizzon RG. Drug-induced linear IgA bullous dermatosis probably induced by furosemide. J Am Acad Dermatol 1999; 41:103-5. [PMID: 10411419 DOI: 10.1016/s0190-9622(99)70414-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Linear IgA bullous dermatosis (LABD) is an autoimmune disease, characterized by linear deposition of IgA along the basement membrane zone. Drug-induced LABD is rare but increasing in frequency. A new case of drug-induced LABD associated with the administration of furosemide is described.
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Affiliation(s)
- J P Cerottini
- Department of Dermatology (CHUV/DHURDV), Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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Nousari HC, Kimyai-Asadi A, Caeiro JP, Anhalt GJ. Clinical, demographic, and immunohistologic features of vancomycin-induced linear IgA bullous disease of the skin. Report of 2 cases and review of the literature. Medicine (Baltimore) 1999; 78:1-8. [PMID: 9990350 DOI: 10.1097/00005792-199901000-00001] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Administration of intravenous vancomycin has been associated with the development of linear IgA bullous disease (LABD). In contrast to the idiopathic variant, vancomycin-induced LABD (VILABD) appears to be more transient and to be associated with lower morbidity. The characteristics of this entity remain undefined. Our analysis of clinical, demographic, and immunopathologic features of 2 new and 14 previously reported patients with VILABD reveals that VILABD is clinically and immunopathologically indistinguishable from its idiopathic variant. A variety of premorbid conditions and concomitant medications were observed, none of which was consistently associated with the development of VILABD. VILABD occurs independently of vancomycin trough levels, resolves promptly upon discontinuation of vancomycin, and recurs more severely and with shorter onset latency with vancomycin rechallenge. This entity should be recognized as 1 of the adverse cutaneous effects of intravenous vancomycin, and warrants prompt diagnosis through direct immunofluorescence skin examination.
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Affiliation(s)
- H C Nousari
- Department of Dermatology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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Tonev S, Vasileva S, Kadurina M. Depot sulfonamid associated linear IgA bullous dermatosis with erythema multiforme-like clinical features. J Eur Acad Dermatol Venereol 1998. [DOI: 10.1111/j.1468-3083.1998.tb00773.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Affiliation(s)
- I S Friedman
- George Washington University School of Medicine, Washington, DC, USA
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Affiliation(s)
- M Camilleri
- University Department of Dermatology, Boffa Hospital, Floriana, Malta
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Wakelin SH, Allen J, Zhou S, Wojnarowska F. Drug-induced linear IgA disease with antibodies to collagen VII. Br J Dermatol 1998; 138:310-4. [PMID: 9602881 DOI: 10.1046/j.1365-2133.1998.02081.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Linear IgA disease (LAD) is characterized by circulating and tissue-bound IgA antibodies against heterogeneous antigens in the cutaneous basement membrane zone. In most cases the cause is unknown, but a minority of cases has been drug induced. We report a 76-year-old man who developed an acute blistering eruption following high-dose penicillin treatment for pneumococcal septicaemia. Indirect immunofluorescence demonstrated dermal binding IgA antibodies, and Western blotting of serum showed reactivity with a 250 kDa dermal antigen corresponding to collagen VII of anchoring fibrils. Indirect immunoelectron microscopy showed antibody labelling in the lamina densa and sublamina densa zone. This is one of the few cases of drug-induced LAD in which the target antigen profile has been characterized, and the first in which the antigen has been shown to correspond to collagen VII.
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Affiliation(s)
- S H Wakelin
- Department of Dermatology, Oxford Radcliffe Hospital, U.K
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Abstract
Drug-induced linear IgA bullous disease most commonly occurs after exposure to vancomycin, but other medications may also trigger the eruption. We describe a 78-year-old man with linear IgA bullous disease related to treatment with phenytoin.
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Affiliation(s)
- J M Acostamadiedo
- Department of Internal Medicine, Mayo Clinic Jacksonville, Florida 32224, USA
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Affiliation(s)
- M Landor
- Catholic Medical Center of Queens and Brooklyn, New York, USA
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25
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Abreu A, Bowers K, Mattson DH, Gaspari AA. Linear IgA bullous dermatosis in association with multiple sclerosis. J Am Acad Dermatol 1994; 31:797-9. [PMID: 7661910 DOI: 10.1016/s0190-9622(09)80044-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- A Abreu
- Department of Medicine, St. Mary's Hospital, Rochester, NY
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Tousignant J, Lafontaine N, Rochette L, Rozenfarb E. Dermatitis herpetiformis induced by nonsteroidal anti-inflammatory drugs. Int J Dermatol 1994; 33:199-200. [PMID: 8169023 DOI: 10.1111/j.1365-4362.1994.tb04952.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- J Tousignant
- Department of Dermatology, Notre-Dame Hospital, Montreal, Québec, Canada
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TOUSIGNANT JACQUELINE, LAFONTAINE NANCY, ROCHETTE LINDA, ROZENEARB EVA. DERMATITIS HERPETIFORMIS INDUCED BY NONSTEROIDAL ANTI-INFLAMMATORY DRUGS. Int J Dermatol 1994. [DOI: 10.1111/j.1365-4362.1994.tb04983.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kuechle MK, Stegemeir E, Maynard B, Gibson LE, Leiferman KM, Peters MS. Drug-induced linear IgA bullous dermatosis: report of six cases and review of the literature. J Am Acad Dermatol 1994; 30:187-92. [PMID: 7904616 DOI: 10.1016/s0190-9622(94)70015-x] [Citation(s) in RCA: 142] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Linear IgA bullous dermatosis (LABD) is an autoimmune subepidermal blistering disease that may be associated with drug exposure. OBJECTIVE Our purpose was to compare the clinical, pathologic, and immunofluorescence findings in drug-induced LABD with those in the idiopathic type. METHODS Six patients with an acute drug eruption were identified who had linear IgA deposition at the basement membrane zone (BMZ). Lesional tissue was examined by brightfield microscopy, and perilesional tissue was examined by direct immunofluorescence (DIF). The presence of circulating BMZ antibody was assayed by indirect immunofluorescence (IIF) on monkey esophagus (ME) and salt-split human skin (SS). RESULTS Histopathologic examination showed subepidermal bullae with varying numbers of inflammatory cells. DIF showed linear IgA at the BMZ; three of the patients also had weak deposition of C3 at the BMZ. Serum from five patients was studied by IIF. One patient had circulating IgA BMZ antibodies in a titer of 1:80 on ME, localized to the dermal side on SS. All patients were free of lesions within 5 weeks after discontinuation of the drug. CONCLUSION Drug-induced LABD is a self-limited eruption characterized by linear deposition of IgA without IgG at the BMZ. Most patients lack circulating antibodies. The distribution of lesions and the course of the disease differ from those of idiopathic LABD.
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Affiliation(s)
- M K Kuechle
- Department of Dermatology, Mayo Clinic, Rochester, MN 55905
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Affiliation(s)
- P M Collier
- Department of Dermatology, Bristol Royal Infirmary, Bristol, and Churchill Hospital, Oxford, United Kingdom
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Vassileva S, Prost C. Discovering vesiculobullous drug eruptions through dermatopathologic techniques. Clin Dermatol 1993; 11:557-65. [PMID: 8124647 DOI: 10.1016/0738-081x(93)90166-a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- S Vassileva
- Department of Dermatology and Venereology, Sofia Faculty of Medicine, Bulgaria
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Abstract
OBJECTIVE To report a case of cephalexin-induced Stevens-Johnson syndrome (SJS), a devastating adverse drug reaction that involves the entire skin surface and mucosal areas of the body. DATA SOURCES MEDLINE search (key terms cephalosporins, Stevens-Johnson syndrome, erythema multiforme, and systemic lupus erythematosus) and references identified from bibliographies of pertinent articles. DATA SYNTHESIS Clinical presentation and manifestations of SJS include the skin, eyes, gastrointestinal tract, and pulmonary system. Infectious complications are the leading cause of mortality. Early intervention is important to prevent progression of SJS. The case described is consistent with the features of this syndrome. The patient presented with fever, arthralgias, and malaise. Skin lesions included a diffuse violet macular rash with erythema and multiple bullous lesions on her neck and abdomen. The skin biopsy was consistent with SJS. Multiple mucocutaneous ulcers were found in her mouth, but no evidence of lower gastrointestinal tract involvement was documented. She remained relatively free of pulmonary complaints except for the presenting bronchitis. CONCLUSIONS Cephalexin should be added to the list of agents to consider as iatrogenic causes of SJS.
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Affiliation(s)
- K M Murray
- College of Pharmacy, University of South Carolina, Columbia
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Abstract
Linear IgA dermatosis with severe arthralgia is a rare clinical syndrome. Streptococcal infection may be important in its pathogenesis. The rash and arthralgia respond to dapsone although additional treatment with non-steroidal anti-inflammatory drugs and/or corticosteroids may be necessary. A case is presented which illustrates these features.
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Godfrey K, Wojnarowska F, Leonard J. Linear IgA disease of adults: association with lymphoproliferative malignancy and possible role of other triggering factors. Br J Dermatol 1990; 123:447-52. [PMID: 2095175 DOI: 10.1111/j.1365-2133.1990.tb01448.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Seventy patients with linear IgA disease of adults were followed up for a mean of 8.5 years and all malignant diseases in this group were ascertained. There were three cases of lymphoproliferative malignancy, which constituted a significant excess over the 0.2 cases that would be expected by comparison with an age- and sex-matched population using National Cancer Registry statistics. In contrast, the non-lymphoid malignancy rate of 13% is almost identical to the expected 14%. A subgroup of 35 of the adult linear IgA disease patients were assessed with respect to the possible precipitating illnesses or drugs, as well as co-existing medical conditions. Almost one-third of patients described an event that was felt could possibly have triggered the linear IgA disease, the most frequent being non-steroidal anti-inflammatory or antibiotic drug therapy, trauma/burns and upper respiratory tract infections. However, it is difficult to determine how often the preceding event is coincidental, and how often, if at all, it is causal.
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