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Ward KE, Steadman L, Karim AR, Reynolds GM, Pugh M, Chua W, Faustini SE, Veenith T, Thwaites RS, Openshaw PJM, Drayson MT, Shields AM, Cunningham AF, Wraith DC, Richter AG. SARS-CoV-2 infection is associated with anti-desmoglein 2 autoantibody detection. Clin Exp Immunol 2023; 213:243-251. [PMID: 37095599 PMCID: PMC10651225 DOI: 10.1093/cei/uxad046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 03/08/2023] [Accepted: 04/24/2023] [Indexed: 04/26/2023] Open
Abstract
Post-acute cardiac sequelae, following SARS-CoV-2 infection, are well recognized as complications of COVID-19. We have previously shown the persistence of autoantibodies against antigens in skin, muscle, and heart in individuals following severe COVID-19; the most common staining on skin tissue displayed an inter-cellular cement pattern consistent with antibodies against desmosomal proteins. Desmosomes play a critical role in maintaining the structural integrity of tissues. For this reason, we analyzed desmosomal protein levels and the presence of anti-desmoglein (DSG) 1, 2, and 3 antibodies in acute and convalescent sera from patients with COVID-19 of differing clinical severity. We find increased levels of DSG2 protein in sera from acute COVID-19 patients. Furthermore, we find that DSG2 autoantibody levels are increased significantly in convalescent sera following severe COVID-19 but not in hospitalized patients recovering from influenza infection or healthy controls. Levels of autoantibody in sera from patients with severe COVID-19 were comparable to levels in patients with non-COVID-19-associated cardiac disease, potentially identifying DSG2 autoantibodies as a novel biomarker for cardiac damage. To determine if there was any association between severe COVID-19 and DSG2, we stained post-mortem cardiac tissue from patients who died from COVID-19 infection. This confirmed DSG2 protein within the intercalated discs and disruption of the intercalated disc between cardiomyocytes in patients who died from COVID-19. Our results reveal the potential for DSG2 protein and autoimmunity to DSG2 to contribute to unexpected pathologies associated with COVID-19 infection.
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Affiliation(s)
- Kerensa E Ward
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, West Midlands, UK
| | - Lora Steadman
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, West Midlands, UK
| | - Abid R Karim
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, West Midlands, UK
| | - Gary M Reynolds
- Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, West Midlands, UK
| | - Matthew Pugh
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, West Midlands, UK
| | - Winnie Chua
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, West Midlands, UK
| | - Sian E Faustini
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, West Midlands, UK
| | - Tonny Veenith
- Department of Critical Care, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ryan S Thwaites
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Mark T Drayson
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, West Midlands, UK
| | - Adrian M Shields
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, West Midlands, UK
- Department of Clinical Immunology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Adam F Cunningham
- Institute of Microbiology and Infection, University of Birmingham, Birmingham, UK
| | - David C Wraith
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, West Midlands, UK
| | - Alex G Richter
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, West Midlands, UK
- Department of Clinical Immunology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Fenner J, Min MS, Liu S, Silverberg N. A case of neonatal pemphigus vulgaris with co-existing BP180 autoantibodies. Pediatr Dermatol 2020; 37:241-243. [PMID: 31774569 DOI: 10.1111/pde.14059] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A male neonate was born with blisters on the trunk to a 37-year-old primigravid woman with a past medical history of recurrent, painful, topical steroid-responsive oral blisters. The diagnosis of neonatal pemphigus was made after the neonate and mother were found to have elevated desmoglein 3 (Dsg3) antibodies in conjunction with histopathologic features of pemphigus vulgaris. Interestingly, both neonate and mother also had elevated levels of BP180 antibodies, classically seen in bullous pemphigoid. This case is unique in that it portrays neonatal pemphigus, an already rare condition, complicated by the presence of BP180 antibodies.
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Affiliation(s)
- Justine Fenner
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Michelle S Min
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Stephanie Liu
- Department of Dermatopathology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Nanette Silverberg
- Departments of Dermatology and Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
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3
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Naramala S, Dalal H, Adapa S, Patel P, Konala VM. Hydrochlorothiazide vs Venlafaxine: Drug-induced Bullous Pemphigoid. Cureus 2019; 11:e4999. [PMID: 31497430 PMCID: PMC6713256 DOI: 10.7759/cureus.4999] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Pemphigoid group of dermatologic conditions is a group of autoimmune skin disorders resulting in blistering skin conditions. The two diseases that fall under this category are bullous pemphigoid and pemphigus vulgaris. While there are many similarities in these two disorders, there are numerous pathologic and biochemical differences which help us differentiate between these disorders. In this case report, we report a usual manifestation of bullous pemphigoid in a 72-year-old female secondary to use of a well-known antihypertensive (hydrochlorothiazide) and/or venlafaxine (anti-depressant).
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Affiliation(s)
| | - Hussain Dalal
- Internal Medicine, Internal Medicine Multi-Specialty Clinic, Houston, USA
| | | | - Pallav Patel
- Internal Medicine, Kaweah Delta Medical Center, Visalia, USA
| | - Venu Madhav Konala
- Internal Medicine/ Hematology and Oncology, Ashland Bellefonte Cancer Center, Ashland, USA
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4
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Kridin K, Bergman R. The Usefulness of Indirect Immunofluorescence in Pemphigus and the Natural History of Patients With Initial False-Positive Results: A Retrospective Cohort Study. Front Med (Lausanne) 2018; 5:266. [PMID: 30386780 PMCID: PMC6199371 DOI: 10.3389/fmed.2018.00266] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 09/03/2018] [Indexed: 11/13/2022] Open
Abstract
The specificity and the predictive values of indirect immunofluorescence (IIF) in real-life settings is yet to be firmly established. The natural history of patients with false-positive results has not been sufficiently elucidated. The primary aim of the current study is to evaluate the diagnostic value of IIF analysis on monkey esophagus in pemphigus, utilizing a large cohort arising from the real-life experience of a tertiary referral center. The secondary endpoint was to determine the clinical outcomes of patients with false-positive results. This was a retrospective cohort study including all patients who were tested for the presence of intercellular autoantibodies by IIF on monkey esophagus between 2000 and 2017. Overall, 770 sera from different individuals were tested by IIF microscopy. Of those, 176 patients had been diagnosed with pemphigus vulgaris (PV) and 29 patients with pemphigus foliaceus (PF). The sensitivity of this immunoassay was significantly higher for the diagnosis of PV (87.4%; 95% CI, 81.5-91.9%) as compared to PF (69.0%; 95% CI, 49.2-84.7%; P = 0.018). The specificity for the diagnosis of pemphigus was 93.5% (95% CI, 91.1-95.4%). Patients with false-positive results (n = 37) were followed for a median duration of 5.3 years contributing 280.8 person-years. Thirty patients (81.1%) were eventually diagnosed clinically and immunopathologically with subepidermal autoimmune bullous diseases, whereas the remaining patients (18.9%) were diagnosed clinically and histologically with other inflammatory dermatoses, but none of them developed pemphigus during the follow-up duration. Of note, 7.0% (n = 23) of all patients diagnosed with bullous pemphigoid (BP) in the same period (n = 328) were tested positive for IgG intercellular antibodies. Histopathological review of the biopsy specimens of these patients did not reveal acantholysis. In conclusion, the predictive value of negative test in IIF on monkey esophagus is particularly reliable to exclude a diagnosis of pemphigus. Individuals tested positive for intercellular antibodies without an initial overt pemphigus did not show an increased risk for developing pemphigus subsequently. A sizable fraction of patients with BP showed circulating intercellular autoantibodies by IIF, without a histopathological evidence for acantholysis.
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Affiliation(s)
- Khalaf Kridin
- Department of Dermatology, Rambam Health Care Campus, Haifa, Israel
| | - Reuven Bergman
- Department of Dermatology, Rambam Health Care Campus, Haifa, Israel.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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5
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Amagai M, Ikeda S, Hashimoto T, Mizuashi M, Fujisawa A, Ihn H, Matsuzaki Y, Ohtsuka M, Fujiwara H, Furuta J, Tago O, Yamagami J, Tanikawa A, Uhara H, Morita A, Nakanishi G, Tani M, Aoyama Y, Makino E, Muto M, Manabe M, Konno T, Murata S, Izaki S, Watanabe H, Yamaguchi Y, Matsukura S, Seishima M, Habe K, Yoshida Y, Kaneko S, Shindo H, Nakajima K, Kanekura T, Takahashi K, Kitajima Y, Hashimoto K. A randomized double-blind trial of intravenous immunoglobulin for bullous pemphigoid. J Dermatol Sci 2017; 85:77-84. [PMID: 27876358 DOI: 10.1016/j.jdermsci.2016.11.003] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 10/14/2016] [Accepted: 11/08/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND Patients with steroid-resistant bullous pemphigoid (BP) require an appropriate treatment option. OBJECTIVE A multicenter, randomized, placebo-controlled, double-blind trial was conducted to investigate the therapeutic effect of high-dose intravenous immunoglobulin (IVIG; 400mg/kg/day for 5days) in BP patients who showed no symptomatic improvement with prednisolone (≥0.4mg/kg/day) administered. METHODS We evaluated the efficacy using the disease activity score on day15 (DAS15) as a primary endpoint, and changes in the DAS over time, the anti-BP180 antibody titer, and safety for a period of 57days as secondary endpoints. RESULTS We enrolled 56 patients in this study. The DAS15 was 12.5 points lower in the IVIG group than in the placebo group (p=0.089). The mean DAS of the IVIG group was constantly lower than that of the placebo group throughout the course of observation, and a post hoc analysis of covariance revealed a significant difference (p=0.041). Furthermore, when analyzed only in severe cases (DAS≥40), the DAS15 differed significantly (p=0.046). The anti-BP180 antibody titers showed no difference between the two groups. CONCLUSION IVIG provides a beneficial therapeutic outcome for patients with BP who are resistant to steroid therapy.
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Affiliation(s)
- Masayuki Amagai
- Department of Dermatology, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo 160-8582, Japan.
| | - Shigaku Ikeda
- Department of Dermatology, Juntendo University School of Medicine, 3-1-3 Hongo, Bunkyou-ku, Tokyo 113-8431, Japan
| | - Takashi Hashimoto
- Department of Dermatology, Kurume University School of Medicine, 67 Asahi-cho, Kurume, Fukuoka 830-0011, Japan
| | - Masato Mizuashi
- Department of Dermatology, Tohoku University School of Medicine, 1-1 Seiryou-cho, aoba-ku, Sendai, Miyagi 980-8574, Japan
| | - Akihiro Fujisawa
- Department of Dermatology, Kyoto University School of Medicine, 54 Shougoin Kawahara-cho, Sakyou-ku, Kyoto-shi, Kyoto 606-8507, Japan
| | - Hironobu Ihn
- Department of Dermatology and Plastic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto-shi, Kumamoto 860-8556, Japan
| | - Yasushi Matsuzaki
- Department of Dermatology, Hirosaki University School of Medicine, 53 Hon-cho, Hirosaki, Aomori 036-8563, Japan
| | - Mikio Ohtsuka
- Department of Dermatology, Fukushima Medical University, 1 Hikarigaoka, Fukushima-shi, Fukushima 960-1295, Japan
| | - Hiroshi Fujiwara
- Department of Dermatology, Niigata University School of Medicine, 1-754 Asahimachidori, Chuo-ku, Niigata-shi, Niigata, 951-8510, Japan
| | - Junichi Furuta
- Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8577, Japan
| | - Osamu Tago
- Department of Dermatology, Gunma University School of Medicine, 3-39-15 Shouwa-machi, Maebashi, Gunma 371-8511, Japan
| | - Jun Yamagami
- Department of Dermatology, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Akiko Tanikawa
- Department of Dermatology, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Hisashi Uhara
- Department of Dermatology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Akimichi Morita
- Department of Dermatology, Nagoya city University School of Medicine, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-860, Japan
| | - Gen Nakanishi
- Department of Dermatology, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga 520-2192, Japan
| | - Mamori Tani
- Department of Dermatology, Osaka University School of Medicine, Setatsukinowa-cho, Otsu, Shiga 520-2192, Japan
| | - Yumi Aoyama
- Department of Dermatology, Okayama University School of Medicine, 2-5-1 Shikata-cho, Kita-ku, Okayama-shi, Okayama 700-8558, Japan
| | - Eiichi Makino
- Department of Dermatology, Kawasaki Medical University, 577 Matsushima, Kurashiki, Okayama 701-0192, Japan
| | - Masahiko Muto
- Department of Dermatology, Yamaguchi University School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505, Japan
| | - Motomu Manabe
- Department of Dermatology and Plastic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita City, Akita 010-8543, Japan
| | - Takayuki Konno
- Department of Dermatology, Yamagata University School of Medicine, 2-2-2 Iidanishi, Yamagata-shi, Yamagata 990-9585, Japan
| | - Satoru Murata
- Department of Dermatology, Jichi Medical University, 3311-1 Yakushiji, Shimono, Tochigi 329-0498, Japan
| | - Seiichi Izaki
- Department of Dermatology, Saitama Medical Center, 1981 Kamoda, Kawagoe, Saitama 350-8550, Japan
| | - Hideaki Watanabe
- Department of Dermatology, Showa University East Hospital, 2-14-19 Nishinakanobu, Shinagawa-ku, Tokyo 142-0054, Japan
| | - Yukie Yamaguchi
- Department of Dermatology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0064, Japan
| | - Setsuko Matsukura
- Department of Dermatology, Yokohama city University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa 232-0024, Japan
| | - Mariko Seishima
- Department of Dermatology, Gifu University School of Medicine, 1-1 Yanagito, Gifu-shi, Gifu 501-1194, Japan
| | - Koji Habe
- Department of Dermatology, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan
| | - Yuichi Yoshida
- Department of Dermatology, Tottori University School of Medicine, 36-1 Nishi-cho, Yonago, Tottori 683-8504, Japan
| | - Sakae Kaneko
- Department of Dermatology, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane 693-8501, Japan
| | - Hajime Shindo
- Department of Dermatology, Hiroshima University School of Medicine, 1-2-3 Kasumi, Minami-ku, Hiroshima-shi, Hiroshima 734-8551, Japan
| | - Kimiko Nakajima
- Department of Dermatology, Kochi University School of Medicine, 185-1 Kohasu, Okou-cho, Nankoku, Kochi 783-8505, Japan
| | - Takuro Kanekura
- Department of Dermatology, Kagoshima University School of Medicine and Dentistry, 8-35-1 Sakuragaoka, Kagosima-shi, Kagoshima 890-8520, Japan
| | - Kenzo Takahashi
- Department of Dermatology, Ryukyu University School of Medicine, 207 Uehara, Nishihara-cho, Nakagami-gun, Okinawa 903-0215, Japan
| | - Yasuo Kitajima
- Kizawa memorial hospital, 590, Shimokobi, Kobicho, Minokamo-shi, Japan
| | - Koji Hashimoto
- Ehime Prefectural University of Health Sciences, 543, Takoda, Tobe-cho, Iyo-gun, Ehime 791-2101, Japan
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Ding S, Deng Q, Xiang Y, Chen J, Huang J, Lu J. Bullous pemphigoid associated with milia, increased serum IgE, autoantibodies against desmogleins, and refractory treatment in a young patient. An Bras Dermatol 2017; 92:34-36. [PMID: 29267440 PMCID: PMC5726671 DOI: 10.1590/abd1806-4841.20176124] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 12/26/2016] [Indexed: 11/21/2022] Open
Abstract
Bullous pemphigoid is a blistering autoimmune disease characterized by two hemidesmosomal proteins (anti-BP180 and 230). Pemphigus, by contrast, is characterized by two autoantibodies (anti-desmoglein 1 and 3). Coexistence of autoantibodies of bullous pemphigoid and pemphigus in a patient is rare. A 25-year-old male patient was admitted to our hospital, reporting a 3-month history of multiple papules, vesicles, and erosions over an extensive erythema on the entire body. Laboratory tests showed high levels of serum IgE, anti-BP180 antibodies, and anti-desmoglein 1 and 3. Histopathologic and immunopathologic features were characterized by bullous pemphigoid. No improvement was seen with systemic corticosteroid therapy, however, pulse corticosteriod therapy combined with methylprednisolone, immunosuppressants, immunomodulators, and plasmapheresis led to the recovery of his condition with numerous milia.
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Affiliation(s)
- Shu Ding
- Department of Dermatology, Third Xiangya Hospital, Central
South University, Changsha, China
| | - Qiancheng Deng
- Department of Dermatology, Third Xiangya Hospital, Central
South University, Changsha, China
| | - Yaping Xiang
- Department of Dermatology, Third Xiangya Hospital, Central
South University, Changsha, China
| | - Jing Chen
- Department of Dermatology, Third Xiangya Hospital, Central
South University, Changsha, China
| | - Jinhua Huang
- Department of Dermatology, Third Xiangya Hospital, Central
South University, Changsha, China
| | - Jianyun Lu
- Department of Dermatology, Third Xiangya Hospital, Central
South University, Changsha, China
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Hosoda S, Adachi A, Suzuki M, Yamada T, Komine M, Murata S, Ohtsuki M. Case of pemphigus with immunoglobulin G and A antibodies, binding to both the intercellular spaces and basement membrane zone. J Dermatol 2015. [PMID: 26219735 DOI: 10.1111/1346-8138.13041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We report a case involving a 62-year-old woman with in vivo-bound immunoglobulin (Ig)G and IgA antibodies in both the intercellular space (ICS) and basement membrane zone (BMZ). Her clinical and histopathological features were identical with those of pemphigus vulgaris, while the immunopathological findings suggested IgG/IgA pemphigus. Direct immunofluorescence (IF) showed in vivo-bound IgG and IgA antibodies in the ICS and BMZ, whereas indirect IF showed circulating IgG but not IgA antibodies in the ICS and BMZ. The anti-ICS IgG bound to desmoglein-3, while the anti-BMZ antibodies bound to the epidermal side of 1 mol/L NaCl-split skin. To the best of our knowledge, only two similar cases have been reported so far. Furthermore, we also examined IgG subclass distribution of the in vivo-bound and circulating anti-ICS and BMZ antibodies, and found that IgG1, IgG2 and IgG4 bound to ICS of the lesional skins, while IgG1 and IgG3 bound to the BMZ. The circulating anti-ICS antibodies belonged to IgG1 and IgG4, while the circulating anti-BMZ antibodies to IgG1, IgG2 and IgG4. We report a case involving a 62-year-old woman with in vivo-bound immunoglobulin (Ig)G and IgA antibodies in both the intercellular space (ICS) and basement membrane zone (BMZ). Her clinical and histopathological features were identical with those of pemphigus vulgaris, while the immunopathological findings suggested IgG/IgA pemphigus. Direct immunofluorescence (IF) showed in vivo-bound IgG and IgA antibodies in the ICS and BMZ, whereas indirect IF showed circulating IgG but not IgA antibodies in the ICS and BMZ. The anti-ICS IgG bound to desmoglein-3, while the anti-BMZ antibodies bound to the epidermal side of 1 mol/L NaCl-split skin. To the best of our knowledge, only two similar cases have been reported so far. Furthermore, we also examined IgG subclass distribution of the in vivo-bound and circulating anti-ICS and BMZ antibodies, and found that IgG1, IgG2 and IgG4 bound to ICS of the lesional skins, while IgG1 and IgG3 bound to the BMZ. The circulating anti-ICS antibodies belonged to IgG1 and IgG4, while the circulating anti-BMZ antibodies to IgG1, IgG2 and IgG4.
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Affiliation(s)
- Satomi Hosoda
- Department of Dermatology, Jichi Medical University, Shimotsuke, Japan
| | - Akimasa Adachi
- Department of Dermatology, Jichi Medical University, Shimotsuke, Japan
| | - Masayuki Suzuki
- Department of Dermatology, Jichi Medical University, Shimotsuke, Japan
| | - Tomoko Yamada
- Department of Dermatology, Jichi Medical University, Shimotsuke, Japan
| | - Mayumi Komine
- Department of Dermatology, Jichi Medical University, Shimotsuke, Japan
| | - Satoru Murata
- Department of Dermatology, Jichi Medical University, Shimotsuke, Japan
| | - Mamitaro Ohtsuki
- Department of Dermatology, Jichi Medical University, Shimotsuke, Japan
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8
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Ono S, Tanioka M, Tanizaki H, Fujisawa A, Koga H, Hashimoto T, Kamiya K, Aoyama Y, Iwatsuki K, Miyachi Y. Concurrence of autoantibodies to bullous pemphigoid antigens and desmoglein 3: analysis of pathogenic and nonpathogenic antibodies. Br J Dermatol 2013; 168:1357-60. [PMID: 23738642 DOI: 10.1111/bjd.12143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
The presence of one autoimmune disorder helps lead to the discovery of other autoimmune conditions. It is thought that diseases in which autoimmunity is a feature tend to be associated together more often than one can ascribe to chance. A variety of diseases have been implicated in the onset of intraepidermal and subepidermal autoimmune diseases. The presence of one autoimmune disease should alert the physician to watch for a second immunologic disorder. A list of autoimmune bullous diseases associations includes autoimmune bullous diseases, pemphigus, pemphigoid, epidermolysis bullosa acquisita, dermatitis herpetiformis (Duhring), linear immunoglobulin A disease, and multiple autoimmune syndrome.
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Affiliation(s)
- Suzana Ljubojevic
- University Department of Dermatology and Venereology, University Hospital Center Zagreb, School of Medicine,University of Zagreb, Croatia.
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10
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YAMAKI F, MAYUZUMI N, IKEDA S, HASHIMOTO T. Immunoglobulin A antibodies against desmoglein 1, envoplakin, periplakin and BP230 in a patient with atypical bullous pemphigoid. J Dermatol 2010; 37:255-8. [DOI: 10.1111/j.1346-8138.2010.00801.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Rossi A, Reszko A, Leach J, Magro CM. Combined bullous pemphigoid and pemphigus vulgaris in an 18-year-old female. J Cutan Pathol 2009; 37:991-6. [DOI: 10.1111/j.1600-0560.2009.01360.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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12
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Smith DI, Swamy PM, Heffernan MP. Off-label uses of biologics in dermatology: Interferon and intravenous immunoglobulin (Part 1 of 2). J Am Acad Dermatol 2007; 56:e1-54. [PMID: 17190617 DOI: 10.1016/j.jaad.2006.06.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2005] [Revised: 05/04/2006] [Accepted: 06/19/2006] [Indexed: 11/29/2022]
Abstract
The introduction of a number of biologic therapies into the market has revolutionized the practice of dermatology. These therapies include interferons, intravenous immunoglobulin, infliximab, adalimumab, etanercept, efalizumab, alefacept, and rituximab. Most dermatologists are familiar with the Food and Drug Administration-approved indications of these medications. However, numerous off-label uses have evolved. As part 1 of a 2-part series, this article will review the literature regarding the off-label uses of the interferons and intravenous immunoglobulin in dermatology.
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13
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Tabuchi K, Nomura M, Murashita H, Fujisawa Y, Tsuji S, Okubo H, Hara A. Coexistence of pemphigus vulgaris and bullous pemphigoid in the upper aerodigestive tract. Auris Nasus Larynx 2006; 33:231-3. [PMID: 16168587 DOI: 10.1016/j.anl.2005.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2005] [Accepted: 07/22/2005] [Indexed: 10/25/2022]
Abstract
Pemphigus vulgaris and bullous pemphigoid are autoimmune blistering diseases of the skin and the mucosa characterized by circulating autoantibodies. Coexistence of these lesions is extremely uncommon. We report herein a case of both pemphigus vulgaris and bullous pemphigoid which occurred in the upper aerodigestive tract. The diagnosis was made based on the circulating autoantibodies and direct immunofluorescent studies. The literature on this subject is reviewed.
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Affiliation(s)
- Keiji Tabuchi
- Department of Otolaryngology, Doctorial Program in Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba 305-8575, Japan.
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Zagorodniuk I, Weltfriend S, Shtruminger L, Sprecher E, Kogan O, Pollack S, Bergman R. A comparison of anti-desmoglein antibodies and indirect immunofluorescence in the serodiagnosis of pemphigus vulgaris. Int J Dermatol 2005; 44:541-4. [PMID: 15985020 DOI: 10.1111/j.1365-4632.2004.02541.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Indirect immunofluorescence (IIF) is the standard method for the detection of pemphigus autoantibodies. Commercially available enzyme-linked immunosorbent assays (ELISAs) have recently become available to measure serum antibodies (Abs) against desmoglein1 (Dsg1) and desmoglein3 (Dsg3). It has been suggested that patients with mucosal-dominant pemphigus vulgaris (PV) have serum Abs against Dsg3 only, patients with mucocutaneous PV have Abs to both Dsg1 and Dsg3, and patients with pemphigus foliaceus (PF) have Abs against Dsg1 only. AIM To compare the sensitivity and specificity of the IIF and ELISA tests in the diagnosis of pemphigus and its subsets. METHODS Thirty-three patients with PV and five patients with PF were studied, and compared with 50 healthy individuals or patients with unrelated skin diseases. Monkey esophagus was used as a substrate for the IIF test. RESULTS The IIF and ELISA tests were each positive in 26 of the 32 (81%) PV patients, and in none (0%) and 3 (6%) of the 50 controls, respectively. Both the IIF and ELISA results were concordant in 69% of the PV patients, and only one of these two tests was positive in the remaining 31% of patients. Forty-six per cent of the PV patients with a positive ELISA test did not have the PV phenotype (mucosal or mucocutaneous) predicted by their autoantibody profile. CONCLUSION The IIF and ELISA tests may be used as complementary tests for the serologic diagnosis of pemphigus.
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Affiliation(s)
- Irena Zagorodniuk
- Department of Dermatology, Rambam Medical Center and the Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Abstract
Bullous pemphigoid (BP) is a chronic, autoimmune, blistering disease observed primarily in the elderly population. Several clinical variants have been described, including classic (bullous), localised, nodular, vegetating, erythrodermic, erosive, childhood and drug-induced forms. Autoantibodies target the BP230 and BP180 antigens, located in the hemidesmosomal complex of the skin basement membrane zone. Subsequent complement activation recruits chemical and cellular immune mediators to the skin, ultimately resulting in blister formation. Both autoantibodies and complement may be detected by various immunofluorescent, immune electron microscopy and molecular biology techniques. Recent trials suggest that potent topical corticosteroids should be considered as first-line therapy. Tetracycline with or without nicotinamide may benefit a subset of patients with mild BP. Oral corticosteroids should rarely exceed 0.75 mg/kg/day and corticosteroid-sparing agents may be useful for recalcitrant disease.
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Affiliation(s)
- Scott R A Walsh
- Division of Dermatology, University of Toronto, Toronto, Ontario, Canada
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Ruetter A, Luger TA. Efficacy and safety of intravenous immunoglobulin for immune-mediated skin disease: current view. Am J Clin Dermatol 2004; 5:153-60. [PMID: 15186194 DOI: 10.2165/00128071-200405030-00003] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Intravenous immunoglobulins (IVIgs) exert a variety of immunomodulating activities and are, therefore, increasingly being used for the treatment of immune-mediated as well as autoimmune diseases. There is also accumulating evidence that high-dose IVIg (hdIVIg) is highly efficacious in the treatment of skin diseases, despite the lack of evidence from randomized, double-blind, placebo-controlled trials. A major advantage of hdIVIg in comparison with other commonly used immunomodulating therapeutic strategies is the excellent safety profile. Accordingly, IVIgs have been used successfully for the treatment of bullous autoimmune diseases such as pemphigus and bullous pemphigoid, dermatomyositis, scleroderma, cutaneous lupus erythematosus, toxic epidermal necrolysis, and erythema exudativum multiforme. In most cases, hdIVIg is effective only in combination with other immunomodulating strategies and allows for the reduction of adjuvants. Adverse effects of hdIVIg are generally mild and self-limiting. These include headache, myalgia, flush, fever, nausea or vomiting, chills, lower backache, changes in blood pressure, and tachycardia. To avoid infusion-related rigors, headaches, and other adverse events, pre-treatment with analgesics, NSAIDs, antihistamines, or low-dose intravenous corticosteroids may be beneficial. Controlled, double-blind, long-term clinical trials and a better understanding of the complex immunomodulating mechanism of IVIg are required to ultimately optimize dose, frequency, duration, and mode of IVIg administration.
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Affiliation(s)
- Anita Ruetter
- Department of Dermatology, University of Münster, Münster, Germany.
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