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Oral immune-mediated disorders with malignant potential/association: An overview. Dis Mon 2023; 69:101349. [PMID: 35337657 DOI: 10.1016/j.disamonth.2022.101349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
A group of oral disorders or conditions, which may result from, or could be triggered by an abnormality in the normal immune response of an individual are known as oral immune-mediated disorders. Some of these disorders have malignant potential, while others are associated with malignancy. In this overview, we will discuss a few of the oral diseases (such as oral lichen planus, primary Sjogren's syndrome, systemic lupus erythematosus, dermatitis herpetiformis, and linear immunoglobulin A bullous dermatosis, to name a few), which are caused due to irregularity in the immune system and are either associated with malignancy or capable of undergoing malignant transforming, thereby increasing the morbidity and mortality rate.
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Kartan S, Shi VY, Clark AK, Chan LS. Paraneoplastic Pemphigus and Autoimmune Blistering Diseases Associated with Neoplasm: Characteristics, Diagnosis, Associated Neoplasms, Proposed Pathogenesis, Treatment. Am J Clin Dermatol 2017; 18:105-126. [PMID: 27878477 DOI: 10.1007/s40257-016-0235-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Autoimmune paraneoplastic and neoplasm-associated skin syndromes are characterized by autoimmune-mediated cutaneous lesions in the presence of a neoplasm. The identification of these syndromes provides information about the underlying tumor, systemic symptoms, and debilitating complications. The recognition of these syndromes is particularly helpful in cases of skin lesions presenting as the first sign of the malignancy, and the underlying malignancy can be treated in a timely manner. Autoimmune paraneoplastic and neoplasm-associated bullous skin syndromes are characterized by blister formation due to an autoimmune response to components of the epidermis or basement membrane in the context of a neoplasm. The clinical manifestations, histopathology and immunopathology findings, target antigens, associated neoplasm, current diagnostic criteria, current understanding of pathogenesis, and treatment options for a selection of four diseases are reviewed. Paraneoplastic pemphigus manifests with clinically distinct painful mucosal erosions and polymorphic cutaneous lesions, and is often associated with lymphoproliferative neoplasm. In contrast, bullous pemphigoid associated with neoplasm presents with large tense subepidermal bullae of the skin, and mild mucosal involvement, but without unique clinical features. Mucous membrane pemphigoid associated with neoplasm is a disorder of chronic subepithelial blisters that evolve into erosions and ulcerations that heal with scarring, and involves stratified squamous mucosal surfaces. Linear IgA dermatosis associated with neoplasm is characterized by annularly grouped pruritic papules, vesicles, and bullae along the extensor surfaces of elbows, knees, and buttocks. Physicians should be aware that these autoimmune paraneoplastic and neoplasm-associated syndromes can manifest distinct or similar clinical features as compared with the non-neoplastic counterparts.
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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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Panasiti V, Rossi M, Devirgiliis V, Curzio M, Bottoni U, Calvieri S. Amoxicillin-clavulanic acid-induced linear immunoglobulin A bullous dermatosis: case report and review of the literature. Int J Dermatol 2009; 48:1006-10. [DOI: 10.1111/j.1365-4632.2009.04104.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Polat M, Lenk N, Kürekçi E, Oztaş P, Artüz F, Alli N. Chronic bullous disease of childhood in a patient with acute lymphoblastic leukemia: possible induction by a drug. Am J Clin Dermatol 2008; 8:389-91. [PMID: 18039023 DOI: 10.2165/00128071-200708060-00010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Linear IgA disease is characterized by the presence of linear IgA deposits in the basement membrane zone of the skin, and circulating basement membrane zone antibodies are detected in 80% of cases. The disease occurs in both adults and children, and is designated adult linear IgA disease in the former and chronic bullous disease of childhood (CBDC) in the latter. We describe a 5-year-old boy with acute lymphoblastic leukemia in remission, in whom CBDC developed after treatment with trimethoprim/sulfamethoxazole (cotrimoxazole). To our knowledge, this is the first reported case of possible drug-induced CBDC.
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Affiliation(s)
- Muhterem Polat
- First Dermatology Department, Ankara Numune Education and Research Hospital, Ankara, Turkey.
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Usmani N, Baxter KF, Child JA, Sheehan-Dare R. Linear IgA disease in association with chronic lymphocytic leukaemia. Br J Dermatol 2004; 151:710-1. [PMID: 15377367 DOI: 10.1111/j.1365-2133.2004.06156.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Keller AS, Bouldin MB, Drage LA, Hauser SC, Davis MDP. Linear IgA bullous dermatosis: an association with ulcerative colitis versus renal cell carcinoma. Dig Dis Sci 2003; 48:783-9. [PMID: 12741472 DOI: 10.1023/a:1022805329847] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
MESH Headings
- Biopsy
- Carcinoma, Renal Cell/diagnosis
- Carcinoma, Renal Cell/immunology
- Carcinoma, Renal Cell/pathology
- Colitis, Ulcerative/diagnosis
- Colitis, Ulcerative/immunology
- Colitis, Ulcerative/pathology
- Diagnosis, Differential
- Humans
- Immunoglobulin A/blood
- Kidney Neoplasms/diagnosis
- Kidney Neoplasms/immunology
- Kidney Neoplasms/pathology
- Male
- Microscopy, Fluorescence
- Middle Aged
- Paraneoplastic Syndromes/diagnosis
- Paraneoplastic Syndromes/immunology
- Paraneoplastic Syndromes/pathology
- Skin/immunology
- Skin/pathology
- Skin Diseases, Vesiculobullous/diagnosis
- Skin Diseases, Vesiculobullous/immunology
- Skin Diseases, Vesiculobullous/pathology
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Affiliation(s)
- A Scott Keller
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
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Holló P, Preisz K, Nemes L, Bíró J, Kárpáti S, Horváth A. Linear IgA dermatosis associated with chronic clonal myeloproliferative disease. Int J Dermatol 2003; 42:143-6. [PMID: 12709006 DOI: 10.1046/j.1365-4362.2003.01438_2.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- P Holló
- Department Dermato-Venerology, Semmelweis University, Budapest, Hungary.
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Affiliation(s)
- S V Guide
- Department of Dermatology, Stanford University School of Medicine, (M.P.M.), Stanford, California, USA
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van der Waal RI, van de Scheur MR, Pas HH, Jonkman MF, Van Groeningen CJ, Nieboer C, Starink TM. Linear IgA bullous dermatosis in a patient with renal cell carcinoma. Br J Dermatol 2001; 144:870-3. [PMID: 11298552 DOI: 10.1046/j.1365-2133.2001.04148.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Linear IgA bullous dermatosis (LABD) is an autoimmune subepidermal bullous disease with heterogeneous clinical manifestations, characterized by linear deposition of IgA along the epidermal basement membrane zone. We report a patient with a metastasized renal cell carcinoma who developed an extensive blistering eruption. The lesions showed immunopathological findings characteristic of LABD. The patient showed a fair response to prednisolone and dapsone. Treatment to control the LABD was no longer required when interferon-alfa was started as palliative therapy for the metastasized renal cell carcinoma. The association of LABD and malignancies has been documented before and is not due to mere chance alone.
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Affiliation(s)
- R I van der Waal
- Department of Dermatology, University Hospital Vrije Universiteit, PO Box 7057, 1007 MB Amsterdam, The Netherlands.
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Affiliation(s)
- C A Egan
- Medicine Service, Section of Dermatology, Salt Lake City Veterans Affairs Medical Center, Utah, USA
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Abstract
We report a patient with four conditions in association with linear IgA disease (LAD), only three of which have been reported previously; these latter are ulcerative colitis, autoimmune thyroid disease and carcinoma of the colon, although the carcinoma may have been caused by the ulcerative colitis in this case. Recently, our patient also presented with respiratory symptoms and was found to have sarcoidosis as well, a previously unreported association of this autoimmune bullous disorder. The aetiology of this development may be related to the patient's HLA status or possibly to his treatment with the immunosuppressive agent cyclophosphamide; it is also possible that it is coincidental.
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Affiliation(s)
- W M Porter
- Department of Dermatology, Chelsea & Westminster Hospital, 369 Fulham Road, London, UK
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Abreu A, Bowers K, Mattson DH, Gaspari AA. Linear IgA bullous dermatosis in association with multiple sclerosis. J Am Acad Dermatol 1994; 31:797-9. [PMID: 7661910 DOI: 10.1016/s0190-9622(09)80044-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- A Abreu
- Department of Medicine, St. Mary's Hospital, Rochester, NY
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Jouan N, Plantin P, Berthou C, Gavanou J, Le Roy JP, Schollhammer M, Le Roux P, Guillet G. [Association of IgA linear dermatitis and non-Hodgkin's malignant lymphoma]. Rev Med Interne 1992; 13:153-5. [PMID: 1410891 DOI: 10.1016/s0248-8663(05)82201-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The association between linear IgA dermatosis and neoplasia has been the subject of several publications which suggest that the association is not fortuitous. We report a new case in which a non-Hodgkin's lymphoma was associated with a linear IgA dermatosis and underline the need for full evaluation in search of an associated neoplasia. However, the neoplasia-LAD association is not a true paraneoplastic syndrome since the two pathologies seldom follow a parallel course.
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Affiliation(s)
- N Jouan
- Service de Dermatologie, CHU Brest
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Abstract
Linear IgA dermatosis with severe arthralgia is a rare clinical syndrome. Streptococcal infection may be important in its pathogenesis. The rash and arthralgia respond to dapsone although additional treatment with non-steroidal anti-inflammatory drugs and/or corticosteroids may be necessary. A case is presented which illustrates these features.
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Godfrey K, Wojnarowska F, Leonard J. Linear IgA disease of adults: association with lymphoproliferative malignancy and possible role of other triggering factors. Br J Dermatol 1990; 123:447-52. [PMID: 2095175 DOI: 10.1111/j.1365-2133.1990.tb01448.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Seventy patients with linear IgA disease of adults were followed up for a mean of 8.5 years and all malignant diseases in this group were ascertained. There were three cases of lymphoproliferative malignancy, which constituted a significant excess over the 0.2 cases that would be expected by comparison with an age- and sex-matched population using National Cancer Registry statistics. In contrast, the non-lymphoid malignancy rate of 13% is almost identical to the expected 14%. A subgroup of 35 of the adult linear IgA disease patients were assessed with respect to the possible precipitating illnesses or drugs, as well as co-existing medical conditions. Almost one-third of patients described an event that was felt could possibly have triggered the linear IgA disease, the most frequent being non-steroidal anti-inflammatory or antibiotic drug therapy, trauma/burns and upper respiratory tract infections. However, it is difficult to determine how often the preceding event is coincidental, and how often, if at all, it is causal.
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Abstract
We report the association of linear IgA dermatosis with hematologic malignancy (chronic lymphatic leukemia and plasmacytoma) in two patients. Ten documented cases of linear IgA dermatosis and internal malignancy have been reported in the literature. The possible association of malignancy and linear IgA dermatosis is discussed.
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Affiliation(s)
- M T McEvoy
- Department of Dermatology, Mayo Clinic, Rochester, MN 55905
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