Recurrent corneal melting in the paraneoplastic pemphigus associated with Castleman's disease

Idiopathic Multicentric Castleman's Disease Presenting with Chorioretinal Undulation: A Case Report

PURPOSE

To describe a case of idiopathic multicentric Castleman's disease (iMCD) with initial ocular involvement, presenting with chorioretinal undulation.

METHODS

Observational case report of iMCD patient with ocular manifestation on fundus photography, auto-fluorescein and swept-source optical coherence tomography (SS-OCT), initially and after treatment.

RESULTS

A 75-year-old patient with painless vision loss for 2 years right eye (RE) and 3-month left eye (LE). Fundus examination revealed several yellow-white lesions along with the inferior arcade, with extensive pigment disturbance of the right eye and exudative retinal detachment of the left eye. SS-OCT showed choroid and retinal pigment epithelium (RPE) undulations, choroid thickening and hyperreflective dots at the choroidal level. Interleukin-6 (IL-6) in the anterior chamber was very high (1595 pg/ml RE and 749.3 pg/ml LE). After cervical lymph node biopsy, the patient was finally diagnosed with iMCD. Siltuximab, an interleukin-6 inhibitor, was administered. After two cycles of therapy, the patient's ocular manifestations improved significantly, the choroid and RPE undulation and the ERD resolved without local treatment.

CONCLUSION

Chorioretinal undulation and elevated IL-6 in intraocular fluid could be ocular manifestations of MCD.

Paraneoplastic pemphigus/paraneoplastic autoimmune multiorgan syndrome: Part I. Clinical overview and pathophysiology

Paraneoplastic pemphigus/paraneoplastic autoimmune multiorgan syndrome (PNP/PAMS) is a highly fatal autoimmune blistering disease. The condition occurs in patients with underlying benign or malignant neoplasms, most commonly lymphoproliferative disorders. Both humoral and cell-mediated immunities contribute to the pathogenesis, and autoantibodies against plakin family proteins are characteristic. Patients typically present with severe stomatitis and polymorphous skin lesions, which are often resistant to treatment. Bronchiolitis obliterans (BO) is a frequent complication which contributes to the high mortality rate of PNP/PAMS. Given the rarity of this disorder and heterogeneity of clinical presentation, clinicians should maintain a high index of suspicion for PNP/PAMS to avoid delayed diagnosis. In this first part of a two-part continuing medical education (CME) series, risk factors, pathogenesis, and clinical features of PNP/PAMS are discussed.

Ocular cicatricial pemphigoid

PURPOSE OF REVIEW

This review offers recommendations for monitoring disease status in ocular cicatricial pemphigoid as well therapeutic options including local and systemic therapies.

RECENT FINDINGS

A negative biopsy on direct immunofluorescence does not preclude a diagnosis of OCP. If a patient's cicatrization is active and/or progressive, systemic immunosuppression should be commenced.

SUMMARY

OCP is a chronic systemic autoimmune disease that requires systemic immunosuppression.

Paraneoplastic Pemphigus and Autoimmune Blistering Diseases Associated with Neoplasm: Characteristics, Diagnosis, Associated Neoplasms, Proposed Pathogenesis, Treatment

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.