Pemphigus and malignancy

Treatment with alpha interferon associated with the development of paraneoplastic pemphigus

The use of interferon (INF) is usually considered safe, the major side-effect being a flu-like syndrome. However, with its ability to alter immune responsiveness, INF has been associated with the induction of autoimmune diseases. We report a patient with Waldenström's macroglobulinaemia who developed a generalized blistering eruption after treatment with systemic INF-alpha 2A (INF) for multiple skin cancers. The patient's skin showed histological features, immunofluorescence findings, and immunoprecipitation diagnostic of paraneoplastic pemphigus. Despite aggressive treatment the patient died. In our patient, the use of INF was temporally related to the development of paraneoplastic pemphigus. Although interferon has been shown to induce other autoimmune diseases, to our knowledge this is only the second report of a patient treated with an interferon who subsequently developed a fatal autoimmune blistering disorder. Paraneoplastic pemphigus is a recently described autoimmune bullous disorder with a poor prognosis. The mechanism by which INF triggered the paraneoplastic pemphigus is not known.

Pemphigus vulgaris associated with spindle cell thymoma

This paper describes the occurrence of fatal pemphigus vulgaris in an 89 year old female, in whom a benign spindle cell thymoma was found at autopsy. The histological appearances of the skin biopsies, thymic tumour and immunofluorescence findings are described. The association between pemphigus and neoplasia is discussed, and the difference between classical pemphigus vulgaris and paraneoplastic pemphigus are evaluated.

Paraneoplastic pemphigus: a subset of patients with pemphigus and neoplasia

We reviewed the clinical, histologic, and immunofluorescence features of 20 patients with pemphigus and neoplasia and compared them with a control group of 17 patients with pemphigus without neoplasia. Patients with neoplasia were divided according to clinical, histologic, and immunofluorescence findings into those with paraneoplastic pemphigus syndrome (12 patients) and those with classic pemphigus vulgaris or pemphigus foliaceus with neoplasia (8 patients). The histologic findings in patients with paraneoplastic pemphigus included acantholysis, interface dermatitis, spongiosis, and satellite keratinocyte necrosis. Histologic findings in the 8 patients with classic pemphigus and neoplasia included acantholysis and spongiosis. Direct immunofluorescence in both paraneoplastic pemphigus and pemphigus with neoplasia showed IgG staining of cell-surface proteins (intercellular substance) and deposition of immunoglobulin at the basement membrane zone. Indirect immunofluorescence with rat bladder substrate was used to differentiate paraneoplastic pemphigus from classic pemphigus. Circulating IgG anti-cell-surface protein antibodies were detected in 4 patients with paraneoplastic pemphigus syndrome; they were absent in 2 patients with pemphigus and neoplasia. Immunoprecipitation of sera from the 4 patients with epithelial staining showed the complex of bands identified in studies of paraneoplastic pemphigus syndrome. We conclude that paraneoplastic pemphigus syndrome has distinct clinical, histologic, and immunologic features that differentiate it from classic pemphigus with underlying neoplasia.

Pemphigus vulgaris and malignancy

A case of oral squamous cell carcinoma with pemphigus vulgaris is reported and the literature is reviewed. Association between the above entities has essentially been founded upon the specificity of cancer-associated antigen. To date, such an antigen has not been adequately defined, and, therefore, any causal relationship between the 2 processes on the grounds of antigenic-specificity of cancer cells remains unjustified. Hence, pemphigus and malignancy may occur as a coexisting phenomenon.

Association of oral pemphigus with chronic lymphocytic leukemia

Pemphigus is a bullous autoimmune disease of the skin and mucosae. Recently pemphigus has been associated with malignant disorders originating from several tissues. Two cases of oral pemphigus associated with chronic lymphocytic leukemia are reported. Direct immunofluorescence studies of oral biopsy material showed a pattern consistent with pemphigus in both cases. The nature of the anti-ICS antibodies was IgG. However, in one case anti-ICS antibodies were detected in the serum while in the other anti-striated-muscle autoantibodies were present. The clinical course and interrelationship of the two disorders are discussed.