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Hodges WT, Badawi AH, Rosman IS, Musiek AC, Shmuylovich L. Bullous pemphigoid with prominent mucosal involvement in the setting of renal allograft rejection. JAAD Case Rep 2024; 44:53-57. [PMID: 38292570 PMCID: PMC10825267 DOI: 10.1016/j.jdcr.2023.09.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024] Open
Affiliation(s)
- Wesley T. Hodges
- Division of Dermatology, Washington University School of Medicine, St. Louis, Missouri
| | - Ahmed H. Badawi
- Division of Dermatology, University of Kansas Medical Center, Kansas City, Kansas
- Freeman Health System Dermatology and Skin Cancer Center, Joplin, Missouri
| | - Ilana S. Rosman
- Division of Dermatology, Washington University School of Medicine, St. Louis, Missouri
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
| | - Amy C. Musiek
- Division of Dermatology, Washington University School of Medicine, St. Louis, Missouri
| | - Leonid Shmuylovich
- Division of Dermatology, Washington University School of Medicine, St. Louis, Missouri
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Cui S, Zhang B, Li L. The relationship between bullous pemphigoid and renal disease and related treatments: a review of the current literature. Expert Rev Clin Immunol 2023; 19:1407-1417. [PMID: 37707350 DOI: 10.1080/1744666x.2023.2249238] [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] [Received: 04/22/2023] [Accepted: 08/14/2023] [Indexed: 09/15/2023]
Abstract
INTRODUCTION Bullous pemphigoid (BP) is the most common autoimmune subepidermal blistering disorder in older adults. There is increasing evidence that BP has connections with renal diseases, such as glomerulopathy and neoplasm; it is also linked to the receipt of renal replacement therapy. AREAS COVERED In this review, we summarize the current evidence that BP is a comorbidity of common renal diseases. Furthermore, our exploration of the characteristics and possible mechanisms underlying these connections provides insights that may facilitate the prevention, diagnosis, and management of BP. EXPERT OPINION There is mounting proof that BP is not just a skin immunological disorder but rather a systemic immune-mediated illness. Quantities of case reports focused on BP as a renal disease comorbidity and the coexistence of them is not accidental. However, the underlying mechanisms are still needed to be investigated. Clinicians should be alert to the comorbidities in order to facilitate effective treatment and improve patient prognosis.
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Affiliation(s)
- Shengnan Cui
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Bingjie Zhang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Li Li
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
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Karamova AE, Chikin VV, Znamenskaya LF, Nefedova MA, Mamedova ES. Pemphigus vegetans: A clinical case. VESTNIK DERMATOLOGII I VENEROLOGII 2019. [DOI: 10.25208/0042-4609-2019-95-2-55-63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Affiliation(s)
- A. E. Karamova
- State Research Center of Dermatovenereology and Cosmetology, Ministry of Health of the Russian Federation
| | - V. V. Chikin
- State Research Center of Dermatovenereology and Cosmetology, Ministry of Health of the Russian Federation
| | - L. F. Znamenskaya
- State Research Center of Dermatovenereology and Cosmetology, Ministry of Health of the Russian Federation
| | - M. A. Nefedova
- State Research Center of Dermatovenereology and Cosmetology, Ministry of Health of the Russian Federation
| | - E. S. Mamedova
- State Research Center of Dermatovenereology and Cosmetology, Ministry of Health of the Russian Federation
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Abdul Salim S, Thomas L, Quorles A, Hamrahian SM, Fülöp T. New diagnosis of bullous pemphigoid after withdrawal of immunosuppressive therapy in a failed renal transplant recipient on hemodialysis. Hemodial Int 2017; 22:E26-E32. [PMID: 29227569 DOI: 10.1111/hdi.12626] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The occurrence of the autoimmune blistering disease, bullous pemphigoid (BP), in patients with failed renal allograft is rare and the few reported cases suggest various provocative factors without reaching a consensus. Here we report the case of a patient presenting with bullous lesions soon after the complete discontinuation of immunosuppressant therapy following renal allograft failure. Skin biopsy confirmed the diagnosis of BP. Administration of systemic corticosteroid controlled the occurrence of BP lesions in our patient. Increased clinical suspicion is warranted in cases of patients with renal transplant failure, since withdrawal of the immunosuppressant therapy could lead to unmasking the underlying autoimmune skin disease.
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Affiliation(s)
- Sohail Abdul Salim
- Division of Nephrology, Department of Internal Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Litty Thomas
- Department of Radiation Oncology & Biomolecular Sciences, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Amanda Quorles
- Division of Nephrology, Department of Internal Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Seyed Mehrdad Hamrahian
- Department of Medicine, Division of Nephrology, Thomas Jefferson University, Philadelphia, PA
| | - Tibor Fülöp
- Division of Nephrology, Department of Internal Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
- Department of Medicine, Division of Nephrology, Faculty of Medicine, University of Debrecen, Hungary
- FMC Extracorporeal Life Support Center, Fresenius Medical Care Hungary, Budapest, Hungary
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Rodríguez-Caruncho C, Bielsa I, Bayés B, Guinovart R, Fernández-Figueras T, Ferrándiz C. Bullous pemphigoid associated with chronic renal allograft rejection: Resolution after transplantectomy. J Am Acad Dermatol 2011; 65:e89-e90. [DOI: 10.1016/j.jaad.2011.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Revised: 05/02/2011] [Accepted: 05/03/2011] [Indexed: 11/27/2022]
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Liaw TY, Hwang SJ, Hwang DY, Chen GS. Bullous pemphigoid in a chronic renal allograft rejection patient: a case report and review of the literature. DERMATOL SIN 2011. [DOI: 10.1016/j.dsi.2011.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Mammen C, White CT, Prendiville J. Childhood bullous pemphigoid: A rare manifestation of chronic renal allograft rejection. J Am Acad Dermatol 2011; 65:217-9. [DOI: 10.1016/j.jaad.2010.02.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2010] [Revised: 02/15/2010] [Accepted: 02/23/2010] [Indexed: 11/29/2022]
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8
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Zaraa I, Sellami A, Bouguerra C, Sellami M, Chelly I, Zitouna M, Makni S, Hmida A, Mokni M, Osman A. Pemphigus vegetans: a clinical, histological, immunopathological and prognostic study. J Eur Acad Dermatol Venereol 2010; 25:1160-7. [DOI: 10.1111/j.1468-3083.2010.03939.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Chen TJ, Lai PC, Yang LC, Kuo TT, Hong HS. Bullous pemphigoid in a renal transplant recipient: a case report and review of the literature. Am J Clin Dermatol 2009; 10:197-200. [PMID: 19354335 DOI: 10.2165/00128071-200910030-00007] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Bullous pemphigoid (BP) is an autoimmune disease with chronic, recurrent bullous eruptions. BP has been reported to be associated with drugs, physical stimuli, malignancies, and immune abnormalities. Its association with renal transplant is rare and only four cases have been reported. We present a case of BP in a 52-year-old man with chronic hepatitis B and C infection who underwent a cadaveric renal transplant 13 years earlier. His graft was still functioning well when BP appeared. The occurrence of BP in our patient might be a result of drugs (furosemide or tacrolimus), viruses, or renal allograft. As the patient was receiving regular T-cell immunosuppressant therapy, his BP lesions were recalcitrant to corticosteroid treatment. We discuss the pathogenesis and treatment of such patients.
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Affiliation(s)
- Ting-Jui Chen
- Department of Dermatology, Wanfang Medical Center and Taipei Medical University, Taipei, Taiwan
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Kulikowska A, Boslaugh SE, Huddleston CB, Gandhi SK, Gumbiner C, Canter CE. Infectious, malignant, and autoimmune complications in pediatric heart transplant recipients. J Pediatr 2008; 152:671-7. [PMID: 18410772 DOI: 10.1016/j.jpeds.2007.10.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2007] [Revised: 08/13/2007] [Accepted: 10/13/2007] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To review clinical courses of pediatric heart transplant survivors after 5 years from transplantation for infections, lymphoproliferative, and autoimmune diseases. STUDY DESIGN A total of 71 patients were examined in 2 groups, infant recipients (underwent transplant <1 year of age, n = 38) and older recipients (underwent transplant >1 year, n = 33). All patients received comparable immunosuppression. Calculated occurrence rates were reported as means per 10 years of follow-up with SEs. Differences were examined by using Poisson regression. RESULTS Infant recipients had significantly higher (P < .001) occurrence rates of severe (mean, 2.04 +/- 0.5) and chronic infections (mean, 4.58 +/- 0.67) compared with older recipients (means, 0.37 +/- 0.19 and 1.87 +/- 0.70, respectively). Types of infections were similar to those in the general population with extremely rare opportunistic infections; however, they were more severe and resistant to treatment. Autoimmune disorders occurred at a frequency comparable with lymphoproliferative diseases and were observed in 7 of 38 infants (18%). Most common were autoimmune cytopenias. CONCLUSIONS Infant heart transplant recipients who survive in the long term have higher occurrence rates of infections compared with older recipients. Autoimmune disorders are a previously unrecognized morbidity in pediatric heart transplantation.
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Rawal A, Sarode R, Curtis BR, Karandikar NJ, Friedman K, Rogers ZR. Acquired Glanzmann's thrombasthenia as part of multiple-autoantibody syndrome in a pediatric heart transplant patient. J Pediatr 2004; 144:672-4. [PMID: 15127012 DOI: 10.1016/j.jpeds.2003.12.040] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Although advances in immunosuppressive therapy have allowed prolonged patient survival, immune dysregulation observed in these patients has increased. We report an 11-year-old female heart transplant recipient in whom Glanzmann thrombasthenia was identified as part of a "multiple autoantibody syndrome" manifesting sequentially as autoimmune hemolytic anemia, thrombocytopenia, and neutropenia.
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Affiliation(s)
- Ajay Rawal
- Department of Pathology, UT Southwestern Medical Center, Dallas, Texas 75390, USA
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Burgan SZ, Sawair FA, Napier SS. Case report: Oral pemphigus vulgaris with multiple oral polyps in a young patient. Int Dent J 2003; 53:37-40. [PMID: 12653338 DOI: 10.1111/j.1875-595x.2003.tb00654.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
A rare case of oral pemphigus vulgaris is presented, which developed initially in a 9-year old Jordanian male. The disease was not well controlled with immunosuppressive therapy and was complicated by the development of multiple oral polyps approximately one year after the onset of symptoms. These lesions were smooth, painless and located particularly on the upper labial gingiva, the labial and buccal mucosae and the tongue. Disease activity continued for approximately nine years until the patient was referred to an oral medicine specialist. Histological examination of the polyps revealed exuberant granulation tissue. Adjustment of the steroid dosage lead to resolution of the oral symptoms and the polyps reduced in number and in size. This case highlights the occurrence of pemphigus vulgaris in young patients, illustrates a rare complication of persistent ulcero-inflammatory disease and emphasises the importance of specialist referral in the management of oral disease.
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Affiliation(s)
- Samar Z Burgan
- Department of Oral and Maxillofacial Surgery, Oral Medicine and Periodontology, Faculty of Dentistry, University of Jordan, Amman, Jordan.
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