1
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Hunjan MK, Bardhan A, Harper N, Balacco DL, Langman G, Suresh V, Heagerty A. IgA nephropathy in adults with epidermolysis bullosa. Clin Exp Dermatol 2023; 48:920-925. [PMID: 37192348 DOI: 10.1093/ced/llad091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 01/23/2023] [Accepted: 03/08/2023] [Indexed: 05/18/2023]
Abstract
Epidermolysis bullosa (EB) is a devastating genetic condition caused by mutations in genes that give rise to aberrant proteins. There are 16 different such proteins implicated in EB that are important in maintaining the integrity of the dermoepidermal junction. It is classified into four major subtypes: (i) EB simplex; (ii) junctional EB (JEB); (iii) dystrophic EB (DEB); and (iv) Kindler EB. Renal disease is a recognized complication of EB and the aetiology is complex. We describe our experience of managing five patients with EB and IgA nephropathy. We recommend that patients with recessive DEB and JEB routinely have the following monitored: renal function, urinary albumin/creatinine ratio, urine analysis, serum albumin levels and immunoglobulins; specifically serum IgA. Management of IgA nephropathy in the context of EB should be tailored to the individual and be carried out within a specialist multidisciplinary team. Our case series provides important insights into the treatment of IgA nephropathy in patients with EB and will help inform treatment in this rare genetic disease. Case series and reports like ours are key in gaining real-life data to quantify the actual risk of morbidity and mortality from each of the treatment modalities discussed.
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Affiliation(s)
- Manrup K Hunjan
- National Adult Epidermolysis Bullosa Unit, Solihull Hospital, University Hospitals Birmingham NHS Foundation Trust, UK
- College of Medical and Dental Sciences, University of Birmingham, UK
| | - Ajoy Bardhan
- National Adult Epidermolysis Bullosa Unit, Solihull Hospital, University Hospitals Birmingham NHS Foundation Trust, UK
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, UK
| | - Natasha Harper
- National Adult Epidermolysis Bullosa Unit, Solihull Hospital, University Hospitals Birmingham NHS Foundation Trust, UK
| | - Dario Leonardo Balacco
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, UK
| | | | - Vijay Suresh
- Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, UK
| | - Adrian Heagerty
- National Adult Epidermolysis Bullosa Unit, Solihull Hospital, University Hospitals Birmingham NHS Foundation Trust, UK
- Institute of Ageing and Inflammation, University of Birmingham, UK
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2
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Ambarsari CG, Palupi-Baroto R, Sinuraya FAG, Suryati E, Widyastuti E, Widhiati S. Nephropathy in a Child with Severe Recessive Dystrophic Epidermolysis Bullosa Treated with Cyclophosphamide: A Case Report. Case Rep Nephrol Dial 2023; 13:75-83. [PMID: 37484797 PMCID: PMC10359707 DOI: 10.1159/000530875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 04/20/2023] [Indexed: 07/25/2023] Open
Abstract
Long-term inflammation and recurrent skin infection in recessive dystrophic epidermolysis bullosa (RDEB) are associated with the presence of immunoglobulin A (IgA)-containing immune complexes in the glomerulus. Only eight pediatric RDEB cases with IgA nephropathy (IgAN) have been documented in English-language literature. Most RDEB patients with IgAN progress to kidney failure within 5 years of diagnosis, indicating that these patients may require more intensive early treatment compared to those with primary IgAN. However, diagnosing IgAN in RDEB cases with severe cutaneous manifestations can be challenging. Herein, we report a rare case of nephropathy in an 11-year-old boy with severe RDEB and a frameshift mutation on the COL7A1 gene, which may manifest as kidney disorders. He presented with persistent hematuria and progressing proteinuria. A presumptive IgAN diagnosis was based on clinical features and increased IgA serum levels, as kidney biopsy was refused by his parents. Nephrotic-range proteinuria persisted despite initial steroid and lisinopril treatment. Monthly intravenous cyclophosphamide (IV CPA; 500 mg/m2) led to proteinuria remission and preservation of kidney function for 2 years posttreatment. We conclude that COL7A1 mutations may result in extracutaneous manifestations, including kidney disorders. The association between IgA-containing immune complex deposits in the glomerulus and recurrent skin infection in RDEB may indicate IgAN, particularly when kidney biopsy is infeasible due to severe skin manifestations. In our case, positive results with IV CPA suggest further investigation is needed to explore its potential role in non-rapidly progressing IgAN in children with RDEB.
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Affiliation(s)
- Cahyani Gita Ambarsari
- Department of Child Health, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
- School of Medicine, University of Nottingham, Nottingham, UK
- Medical Technology Cluster, Indonesian Medical Education and Research Institute (IMERI), Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Retno Palupi-Baroto
- Department of Child Health, Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | | | - Elvi Suryati
- Department of Child Health, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
- Department of Child Health, Faculty of Medicine Universitas Lampung - Abdoel Moeloek General Hospital, Bandar Lampung, Indonesia
| | - Etty Widyastuti
- Puri Betik Hati Women and Children Hospital, Bandar Lampung, Indonesia
| | - Suci Widhiati
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Sebelas Maret, Dr. Moewardi Hospital, Surakarta, Indonesia
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3
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Betancourt NJ, Sum K, Gorell ES, Tang JY, Chiou AS. Asymptomatic, microscopic hematuria in epidermolysis bullosa: A single center retrospective case series. J Am Acad Dermatol 2022; 87:1419-1421. [PMID: 36007691 DOI: 10.1016/j.jaad.2022.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 07/19/2022] [Accepted: 08/09/2022] [Indexed: 11/16/2022]
Affiliation(s)
| | - Katie Sum
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California
| | - Emily S Gorell
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California; Department of Dermatology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Jean Y Tang
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California
| | - Albert S Chiou
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California.
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4
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Wang W, Guo Q, Chen J, Zhang X, Li C, Li S, Liang J, Hao C, Wang J. Identification of a novel homozygous LAMB3 mutation in a Chinese male with junctional epidermolysis bullosa and severe urethra stenosis: A case report. Front Genet 2022; 13:965375. [PMID: 36246619 PMCID: PMC9561087 DOI: 10.3389/fgene.2022.965375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/01/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction: Epidermolysis bullosa (EB) is a skin fragility disorder that is caused by molecular aberrations in the epidermal basement membrane zone. Based primarily on the cleavage plane within the skin, EB is classified into four major subtypes: EB simplex; junctional EB (JEB); dystrophic EB; and Kindler EB. The junctional form (JEB) can lead to blistering and a variety of extracutaneous complications, including genitourinary tract involvement. Despite therapeutic progress, treatment modalities for urological complications of JEB are currently limited. Results: We present the case of a Chinese male with intermediate JEB and profound urinary tract stenosis. Due to the progression of the urinary tract stenosis, he presented with repeated urological symptoms, such as high frequency of urination, painful urination, and difficult voiding. After birth, multiple blisters on the fingers, feet, and limbs, as well as nail dystrophies and spare hair were noted. Mutation analysis revealed that the patient carried a homozygous frameshift mutation in the LAMB3 gene [c.1172_1179delinsTGTGTGTGCAAGGAG/p. (P391Lfs*23)]. After receiving treatment for urethral dilatation, lingual mucosa for anterior urethroplasty, and repair of urethral stricture using a ventral onlay penile skin flap, the patient still experienced a relapse of urinary tract stenosis. Finally, the patient underwent perineal urethrostomy. In contrast, his older brother with similar urological symptoms received regular urethral dilatation, and the curative effect was positive. Conclusion: Here we report on a case with a novel LAMB3 mutation that led to JEB with profound urinary tract stenosis, which has expanded our experience in the treatment of EB urological complications.
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Affiliation(s)
- Wei Wang
- Department of Urology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Qiang Guo
- Department of Urology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Jinshan Chen
- The Second Medicine College, Shanxi Medical University, Taiyuan, China
| | - Xi Zhang
- Department of Urology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Chengyong Li
- Department of Urology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Shuangping Li
- Department of Urology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Jialin Liang
- Department of Urology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Chuan Hao
- Department of Urology, The Second Hospital of Shanxi Medical University, Taiyuan, China
- *Correspondence: Chuan Hao, ; Jingqi Wang,
| | - Jingqi Wang
- Department of Urology, The Second Hospital of Shanxi Medical University, Taiyuan, China
- *Correspondence: Chuan Hao, ; Jingqi Wang,
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5
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Mattioli G, Diociaiuti A, Rossi S, Zambruno G, Carlucci M, Pisaneschi E, El Hachem M. ITGB4-mutated Junctional Epidermolysis Bullosa without Pyloric Atresia Presenting with Severe Urinary Involvement and Late-onset Minimal Skin Fragility: Diagnostic and Therapeutic Challenges. Acta Derm Venereol 2022; 102:adv00706. [DOI: 10.2340/actadv.v102.935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract is missing (Short communication)
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6
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Yu L, Huang G, Lu Z, Wang J, Gu W, Li J, Mao J. Glomerular IgA Deposition and Serum Antineutrophil Cytoplasmic Antibody Positivity in a Child With Dystrophic Epidermolysis Bullosa: Case Report and Literature Review. Front Pediatr 2022; 10:939069. [PMID: 35899130 PMCID: PMC9309483 DOI: 10.3389/fped.2022.939069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 06/15/2022] [Indexed: 11/13/2022] Open
Abstract
Patients with epidermolysis bullosa (EB) could develop significant urological complications, such as hydroureteronephrosis, renal amyloidosis and IgA nephropathy (IgAN). Here, we presented a 12-year-old boy carrying pathogenic COL7A1 mutation with diagnosis of dystrophic epidermolysis bullosa (DEB). The patient had concomitant gross hematuria and proteinuria. Pathological examinations and immunostaining of renal biopsy showed glomeruli with mesangial hypercellularity and deposition of IgA, which were indicative of IgAN. Interestingly, serological evaluation showed antineutrophil cytoplasmic antibody (ANCA) directed against myeloperoxidase and proteinase 3. Treatment with glucocorticoid, immunosuppressants, angiotensin-converting enzyme inhibitor and antibiotics efficiently improved hemato-proteinuria, and ANCAs became negative as well. This case of DEB presented a unique collection of clinical manifestations and pathological alterations. IgAN and serum positive ANCA were possibly associated with sustained infection secondary to DEB, and can be managed by empirical treatment for primary IgAN.
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Affiliation(s)
- Ling Yu
- Department of Nephrology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Guoping Huang
- Department of Nephrology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Zhihong Lu
- Department of Nephrology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Jingjing Wang
- Department of Nephrology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Weizhong Gu
- Department of Pathology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Junping Li
- Department of Pathology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Jianhua Mao
- Department of Nephrology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
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7
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Cicek N, Yildiz N, Asadov R, Yucelten AD, Tugtepe H, Alpay H. Kidney and Urinary Tract Involvement in Epidermolysis Bullosa: Is Routine Follow-Up Necessary? Dermatol Pract Concept 2021; 11:e2021051. [PMID: 34123558 DOI: 10.5826/dpc.1103a51] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2021] [Indexed: 10/31/2022] Open
Abstract
Background Several renal and urinary tract complications have been reported in patients with epidermolysis bullosa. Objective This study investigated kidney and urinary tract involvement in patients with epidermolysis bullosa. Patients and Methods Patients with epidermolysis bullosa in treatment at the Dermatology Unit were included in the study. Glomerular and tubular functions were investigated. Results The study included 16 patients (4 females, 12 males) of mean 11.1 years (SD = 8.1 years). Estimated GFR was normal in all patients except one with end-stage renal disease. Excluding this patient, the urinary albumin/creatinine ratio and the fractional excretion of sodium were normal. The mean beta-2 microglobulin/creatinine ratio was 278.8 μg/g, and it was abnormally high in 2 patients. The mean tubular phosphorus reabsorption was 92.6%; it was abnormally low in 1 patient. Severe kidney or urinary tract involvement was present in 2 patients with recessive dystrophic EB-generalized severe (RDEB-GS): one patient had obstructive bullous lesions in the urethra; the other had end-stage renal disease secondary to focal segmental glomerulosclerosis and was on peritoneal dialysis for 3 years. Conclusions Assessment for renal and urinary tract involvement should become a routine part of the evaluation of patients with any type of EB, but especially of patients with RDEB-GS. Patients with mild tubular dysfunction need long-term follow-up to detect early deterioration of renal function.
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Affiliation(s)
- Neslihan Cicek
- Department of Pediatric Nephrology, Marmara University School of Medicine, Istanbul, Turkey
| | - Nurdan Yildiz
- Department of Pediatric Nephrology, Marmara University School of Medicine, Istanbul, Turkey
| | - Ruslan Asadov
- Department of Radiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Ayse Deniz Yucelten
- Department of Dermatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Halil Tugtepe
- Department of Pediatric Urology, Marmara University School of Medicine, Istanbul, Turkey
| | - Harika Alpay
- Department of Pediatric Nephrology, Marmara University School of Medicine, Istanbul, Turkey
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8
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Giannoudis VP, Panteli M, Aderinto J, Giannoudis PV. Reverse oblique proximal femoral fracture in dystrophic epidermolysis bullosa: challenges and recommendations. BMJ Case Rep 2021; 14:14/1/e238483. [PMID: 33495183 PMCID: PMC7839884 DOI: 10.1136/bcr-2020-238483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
A 35-year-old woman attended the emergency department after sustaining a reverse oblique proximal femur fracture, which was amenable to intramedullary nailing. Her presentation was complicated by a background of severe generalised recessive dystrophic epidermolysis bullosa, with extensive blistering of most of her skin, including the area over the standard surgical incision sites. For the successful management of this case, extensive input from the multidisciplinary team was required, with the team facing several challenges. The whole approach to nursing and surgical management (anaesthesia, positioning, fracture reduction and wound care) had to be modified, taking great care to protect the skin at any cost, therefore reducing the risk of a surgical site infection which would be catastrophic. The management of this patient can set a framework that can be followed in similar cases, aiming for a favourable outcome of such challenging, rare conditions.
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Affiliation(s)
- Vasileios P Giannoudis
- Academic Department of Trauma & Orthopaedic Surgery, School of Medicine, University of Leeds, Leeds, UK,Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Michalis Panteli
- Academic Department of Trauma & Orthopaedic Surgery, School of Medicine, University of Leeds, Leeds, UK,Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Joseph Aderinto
- Academic Department of Trauma & Orthopaedic Surgery, School of Medicine, University of Leeds, Leeds, UK,Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Peter V Giannoudis
- Academic Department of Trauma & Orthopaedic Surgery, School of Medicine, University of Leeds, Leeds, UK,Leeds Teaching Hospitals NHS Trust, Leeds, UK
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9
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Hughley E, Nehus EJ, VandenHeuvel K, Augsburger BD, Jain NG, Lucky AW. Glomerulonephritis in Youth With Dystrophic Epidermolysis Bullosa. Kidney Int Rep 2020; 6:538-543. [PMID: 33615081 PMCID: PMC7879098 DOI: 10.1016/j.ekir.2020.10.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/27/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Erica Hughley
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Edward J Nehus
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Katherine VandenHeuvel
- Division of Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Bret D Augsburger
- Division of Dermatology and Cincinnati Children's Epidermolysis Bullosa Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Namrata G Jain
- Division of Pediatric Nephrology, Columbia University Medical Center, New York, NY, USA
| | - Anne W Lucky
- Division of Dermatology and Cincinnati Children's Epidermolysis Bullosa Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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10
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Abstract
Epidermolysis bullosa (EB) is an inherited, heterogeneous group of rare genetic dermatoses characterized by mucocutaneous fragility and blister formation, inducible by often minimal trauma. A broad phenotypic spectrum has been described, with potentially severe extracutaneous manifestations, morbidity and mortality. Over 30 subtypes are recognized, grouped into four major categories, based predominantly on the plane of cleavage within the skin and reflecting the underlying molecular abnormality: EB simplex, junctional EB, dystrophic EB and Kindler EB. The study of EB has led to seminal advances in our understanding of cutaneous biology. To date, pathogenetic mutations in 16 distinct genes have been implicated in EB, encoding proteins influencing cellular integrity and adhesion. Precise diagnosis is reliant on correlating clinical, electron microscopic and immunohistological features with mutational analyses. In the absence of curative treatment, multidisciplinary care is targeted towards minimizing the risk of blister formation, wound care, symptom relief and specific complications, the most feared of which - and also the leading cause of mortality - is squamous cell carcinoma. Preclinical advances in cell-based, protein replacement and gene therapies are paving the way for clinical successes with gene correction, raising hopes amongst patients and clinicians worldwide.
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11
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Soliman KM, Fülöp T, Ploth DW, Herberth J. Diffuse membranoproliferative glomerulonephritis with focal sclerosis and renal amyloidosis in an adult male with autosomal dominant dystrophic epidermolysis bullosa: a case report. Ren Fail 2020; 41:850-854. [PMID: 31498016 PMCID: PMC6746271 DOI: 10.1080/0886022x.2019.1614056] [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] [Indexed: 11/27/2022] Open
Abstract
Previous reports of glomerular disease in adult patients with autosomal dominant dystrophic epidermolysis bullosa (EB) are limited and include post-infectious glomerulonephritis, IgA nephropathy, amyloidosis, and leukocytoclastic vasculitis. To our knowledge, membranoproliferative glomerulonephritis (MPGN) has not been described before. We report a case of a 39-year-old male with autosomal dominant dystrophic EB, presenting with bilateral leg swelling of one-week duration. There was no other significant past medical history. The physical examination was remarkable for scars and erosions over all body areas, with all extremities with blisters and ulcers covered, absent finger and toenails and bilateral lower extremity edema. Serum creatinine was 0.9 mg/dL, albumin 1.3 g/dL and urine protein excretion 3.7 g/24 h. Viral markers (hepatitis-B, C, and HIV), complement c3 and c4 levels and auto-immune antibody profile all remained negative or within normal limits. Renal ultrasound and echocardiogram were normal. Renal biopsy recovered 14 glomeruli, all with proliferation of mesangial and endothelial cells as well as an expansion of the mesangial matrix, focal segmental sclerosis and amorphous homogeneous deposits demonstrating apple-green birefringence under polarized light with Congo red stain. Our observation emphasizes the importance of recognizing MPGN and secondary amyloidosis in patients with EB, especially with the availability of newer treatment modalities.
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Affiliation(s)
- Karim M Soliman
- Department of Medicine, Division of Nephrology, Medical University of South Carolina , Charleston , SC , USA.,Department of Medicine, Division of Nephrology, Cairo University , Cairo , Egypt
| | - Tibor Fülöp
- Department of Medicine, Division of Nephrology, Medical University of South Carolina , Charleston , SC , USA.,Medical Services, Ralph H. Jonson VA Medical Center , Charleston , SC , USA
| | - David W Ploth
- Department of Medicine, Division of Nephrology, Medical University of South Carolina , Charleston , SC , USA
| | - Johann Herberth
- Medical Services, Ralph H. Jonson VA Medical Center , Charleston , SC , USA
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12
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Ito T, Ishikawa E, Matsuo H, Fujimoto M, Murata T, Isoda K, Mizutani H, Ito M. Maintenance Hemodialysis Using Native Arteriovenous Fistula in a Patient with Severe Generalized Recessive Dystrophic Epidermolysis Bullosa. Case Rep Nephrol Dial 2016; 6:96-100. [PMID: 27722157 PMCID: PMC5043167 DOI: 10.1159/000447554] [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: 03/15/2016] [Accepted: 06/12/2016] [Indexed: 11/23/2022] Open
Abstract
Renal failure and infectious disease are strongly associated with morbidity and mortality in patients with severe generalized recessive dystrophic epidermolysis bullosa (RDEB-sev gen). However, it is reportedly difficult to introduce hemodialysis with an arteriovenous fistula (AVF). We encountered a 32-year-old man with RDEB-sev gen in whom hemodialysis with a native AVF was introduced that favorably affected his long-term survival. This patient eventually died because of cachexia related to the recurrence of cutaneous squamous cell carcinoma 51 months after hemodialysis introduction. We believe that in this patient, the frequency of vascular access troubles related to infection or reduction of blood flow was probably low as a result of hemodialysis with his native AVF. Thus, it seems likely that patients with RDEB-sev gen with end stage kidney disease who are on hemodialysis can be successfully managed with a native AVF.
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Affiliation(s)
- Takayasu Ito
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Eiji Ishikawa
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hiroshi Matsuo
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Mika Fujimoto
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Tomohiro Murata
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Kenichi Isoda
- Department of Dermatology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hitoshi Mizutani
- Department of Dermatology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Masaaki Ito
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
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13
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Mellerio JE, Robertson SJ, Bernardis C, Diem A, Fine JD, George R, Goldberg D, Halmos GB, Harries M, Jonkman MF, Lucky A, Martinez AE, Maubec E, Morris S, Murrell DF, Palisson F, Pillay EI, Robson A, Salas-Alanis JC, McGrath JA. Management of cutaneous squamous cell carcinoma in patients with epidermolysis bullosa: best clinical practice guidelines. Br J Dermatol 2015; 174:56-67. [PMID: 26302137 DOI: 10.1111/bjd.14104] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2015] [Indexed: 12/24/2022]
Abstract
This article summarizes recommendations reached following a systematic literature review and expert consensus on the diagnosis and management of cutaneous squamous cell carcinomas in people with epidermolysis bullosa. The guidelines are intended to help inform decision making by clinicians dealing with this complex complication of a devastating disease.
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Affiliation(s)
- J E Mellerio
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, U.K.,Department of Dermatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, U.K
| | - S J Robertson
- Department of Dermatology, The Royal Melbourne Hospital, The Royal Children's Hospital and Monash Medical Centre, Melbourne, Australia
| | - C Bernardis
- Department of Plastic Surgery, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, U.K
| | - A Diem
- Department of Dermatology, Paracelsus Medical University, Salzburg, Austria
| | - J D Fine
- Division of Dermatology, Vanderbilt University School of Medicine, Nashville, TN, U.S.A
| | - R George
- Department of Palliative Care, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, U.K
| | - D Goldberg
- Division of Dermatology, University of Massachusetts, Worcester, MA, U.S.A
| | - G B Halmos
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Centre Groningen, Groningen, the Netherlands
| | - M Harries
- Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, U.K
| | - M F Jonkman
- Department of Dermatology, University Medical Centre Groningen, Groningen, the Netherlands
| | - A Lucky
- Department of Dermatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, U.S.A
| | - A E Martinez
- Department of Dermatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, U.K
| | - E Maubec
- Department of Dermatology, APHP, Avicenne Hospital, Bobigny, France
| | - S Morris
- Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, U.K
| | - D F Murrell
- Department of Dermatology, St George Hospital, University of New South Wales, Sydney, Australia
| | - F Palisson
- Facultad de Medicina, Clínica Alemana, Santiago, Chile
| | - E I Pillay
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, U.K
| | - A Robson
- Department of Dermatopathology, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, U.K
| | - J C Salas-Alanis
- Basic Sciences Department, Universidad de Monterrey, Monterrey, Mexico
| | - J A McGrath
- St John's Institute of Dermatology, King's College London (Guy's Campus), London, U.K
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Ungureanu S, Adni T, Brown T, Inston N, Heagerty A. Successful renal transplant in a patient with non-Herlitz junctional epidermolysis bullosa. Clin Exp Dermatol 2014; 39:330-2. [DOI: 10.1111/ced.12300] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2013] [Indexed: 11/28/2022]
Affiliation(s)
- S. Ungureanu
- Department of Dermatology; Solihull Hospital; Heart of England NHS Foundation Trust; Birmingham UK
| | - T. Adni
- Department of Dermatology; Solihull Hospital; Heart of England NHS Foundation Trust; Birmingham UK
| | - T. Brown
- Renal Surgery Department; Queen Elizabeth Hospital; Birmingham UK
| | - N. Inston
- Renal Surgery Department; Queen Elizabeth Hospital; Birmingham UK
| | - A. Heagerty
- Department of Dermatology; Solihull Hospital; Heart of England NHS Foundation Trust; Birmingham UK
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15
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Fu T, Lingala B, Kent K, Bachrach L, Bruckner A. Patterns of bone mineral acquisition in children with epidermolysis bullosa: a longitudinal study. Br J Dermatol 2011; 165:1081-6. [DOI: 10.1111/j.1365-2133.2011.10517.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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16
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Pagliarello C, Tabolli S. Factors affecting quality of life in epidermolysis bullosa. Expert Rev Pharmacoecon Outcomes Res 2010; 10:329-38. [PMID: 20545597 DOI: 10.1586/erp.10.28] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Epidermolysis bullosa is a rare group of inherited disorders that manifests as blistering or erosion of the skin in response to little or no apparent trauma. Patients suffer from long-term physical, social and economic consequences. Despite the fact that quality of life assessment has rapidly become a significant outcome variable in dermatology research, only a few studies regarding epidermolysis bullosa patients are available. This paper reviews studies evaluating the effect of epidermolysis bullosa on quality of life in patients and caregivers in order to assess which factors can best describe their health-related quality of life. Currently, considerable deficits prevail in both the diagnosis and treatment of rare skin diseases. Moreover, the psychological and social morbidities very easily evade the eyes of clinicians. Comparison of the impact of epidermolysis bullosa with that of other conditions is clearly valuable for making public policy decisions. This review indicates the need for more rigorous exploration of the impact of such diseases to further guide treatment and to monitor quality of care.
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Affiliation(s)
- Calogero Pagliarello
- Health Service Research Unit, IDI IRCCS, Via Monti di Creta 104, 00167 Rome, Italy
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17
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Hernández-Martín A, Torrelo A. Epidermólisis ampollosas hereditarias: del diagnóstico a la realidad. ACTAS DERMO-SIFILIOGRAFICAS 2010. [DOI: 10.1016/j.ad.2010.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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18
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Almaani N, Mellerio JE. Genitourinary Tract Involvement in Epidermolysis Bullosa. Dermatol Clin 2010; 28:343-6, xi. [DOI: 10.1016/j.det.2010.01.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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19
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Fine JD, Mellerio JE. Extracutaneous manifestations and complications of inherited epidermolysis bullosa: part I. Epithelial associated tissues. J Am Acad Dermatol 2009; 61:367-84; quiz 385-6. [PMID: 19700010 DOI: 10.1016/j.jaad.2009.03.052] [Citation(s) in RCA: 160] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2008] [Revised: 02/22/2009] [Accepted: 03/03/2009] [Indexed: 01/05/2023]
Abstract
Based upon case reports and small case series, it has been known for many years that some types and subtypes of inherited epidermolysis bullosa (EB) may be at risk for developing one or more extracutaneous complications. Many of these are associated with considerable morbidity; some may result in death. Only over the past few years have there been data generated from large, well characterized cohorts. However, these data, to date, have been published almost exclusively in the nondermatologic literature. Our objective is to provide dermatologists with a comprehensive review of each major extracutaneous complication with a summary of the pertinent literature and recommendations for evaluation and optimal management. Part I highlights epithelial associated tissues, and part II addresses other organs. Based on these reviews, the readership should gain a greater understanding of the types of complications that may occur, when they are most likely to develop, and the range of medical and surgical interventions that are currently available. It should also be possible for the reader to develop surveillance strategies based on an understanding of the published evidence-based data. The breadth and range of severity of complications that arise in some EB types and subtypes within the external eye, ear, nose, upper airway, and gastrointestinal and genitourinary tracts suggest that optimal management must be multidisciplinary. Given the unique knowledge that dermatologists have of this disease, we believe that the care of the EB patient should be under the direction of his or her dermatologist, who can best assist in timely referrals to those specialists who are most experienced in the care of specific extracutaneous problems.
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Affiliation(s)
- Jo-David Fine
- The National Epidermolysis Bullosa Registry, and Department of Medicine (Dermatology), Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
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20
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Alexandroff AB, Harman KE. Blistering skin disorders: an evidence-based update. Conference report. Br J Dermatol 2008; 160:502-4. [PMID: 18945308 DOI: 10.1111/j.1365-2133.2008.08857.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Evidence-based update meetings are held annually by the Centre of Evidence Based Dermatology, University of Nottingham. Past topics have included important themes such as eczema, psoriasis, hair disorders and skin cancers. This year, the seventh Evidence Based Update meeting focused on blistering disorders and took place in Loughborough University on 5 June 2008. The latest data on incidence and mortality, therapeutic trials and management of bullous pemphigoid, pemphigus and epidermolysis bullosa (EB) were presented by an international panel of renowned speakers. The highlights of the meeting included an informal atmosphere, an international perspective, a practical question and answer session and hearing first-hand a patient and carer's perspective of living with EB.
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Affiliation(s)
- A B Alexandroff
- Department of Dermatology, Leicester Royal Infirmary, Infirmary Square, Leicester LE1 5WW, UK.
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Abstract
IgA nephropathy (IgAN) is the most common pattern of primary glomerulonephritis seen in the Western world. In the majority of cases the cause remains unknown. Cases of familial IgAN and secondary IgAN have been reported and these have provided insights into underlying genetic and environmental triggers for this common glomerular disease. Secondary IgAN is seen most commonly in patients with liver disease or mucosal inflammation, in particular affecting the gastrointestinal tract. A number of dietary and microbial antigens have been identified in circulating IgA immune complexes and mesangial IgA deposits, suggesting that environmental factors may play a role in the pathogenesis of IgAN. There is an increasing literature reporting associations between IgAN and other diseases. Whether these reports represent chance associations or genuine shared pathophysiology is discussed.
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Affiliation(s)
- Shideh Pouria
- Renal Unit, New Guy's House, Guy's Hospital, London, United Kingdom
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22
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Tammaro F, Calabrese R, Aceto G, Lospalluti L, Garofalo L, Bonifazi E, Piccolo T, Pannarale G, Penza R. End-stage renal disease secondary to IgA nephropathy in recessive dystrophic epidermolysis bullosa: a case report. Pediatr Nephrol 2008; 23:141-4. [PMID: 17955267 DOI: 10.1007/s00467-007-0577-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2007] [Revised: 06/25/2007] [Accepted: 07/03/2007] [Indexed: 11/29/2022]
Abstract
Epidermolysis bullosa (EB) consists of a group of dominant or recessive autosomal diseases characterised by skin and mucosa fragility. The lesions leave erosions and scars that, in turn, can cause stenosis of tracheal, oesophageal, and genitourinary tract mucosae. The significantly increased survival of EB patients has determined the onset of complications never observed before, including genitourinary disorders such as hydroureteronephrosis, recurrent urinary tract infections, renal amyloidosis, IgA nephropathy and post-infectious glomerulonephritis. A 6-year-old boy diagnosed with recessive dystrophic EB Hallopeau-Siemens type (RDEB-HS) was referred to our clinic because of microhaematuria that evolved into intra-infectious macrohaematuria. Renal biopsy revealed an increase in both extracellular matrix and mesangial cells, with a focal segmental glomerulosclerosis with severe chronic tubulointerstitial damage. Immunofluorescence showed IgA mesangium deposits. Five years later, he was started on haemodialysis, because of worsening renal function. This is a rare case of a child with EB who was successfully treated with haemodialysis. The pertinent literature has been reviewed.
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Affiliation(s)
- Fabiana Tammaro
- Department of Biomedicine of Developing Age, U.O. B Trambusti, University of Bari, Piazza Giulio Cesare, 11, 70124 Bari, Italy
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