1
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Wang KL, Lehman JS, Davis DMR. Linear IgA bullous dermatosis of childhood: Retrospective single-center cohort. Pediatr Dermatol 2024. [PMID: 38378007 DOI: 10.1111/pde.15567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 02/02/2024] [Indexed: 02/22/2024]
Abstract
Linear IgA bullous dermatosis (LABD) is a rare autoimmune blistering disorder impacting children and adults. In this single-center retrospective chart review of pediatric patients with LABD at a large tertiary referral center, we report the unifying and unique clinical features of 10 pediatric patients. Patients typically presented with the "cluster of jewels" sign (n = 6; 60%), mucous membrane involvement (n = 5; 50%) and had a mean disease duration of 38 months; six patients (60%) required inpatient admission for management of their skin disease, including all five patients who had mucous membrane involvement. Our findings suggest that pediatric LABD may be a disease with high morbidity and may be associated with severe complications when mucous membranes are involved.
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Affiliation(s)
| | - Julia S Lehman
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Dawn M R Davis
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
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2
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Barker CS, Bruner E, Self S, Elston DM. U-serrated and n-serrated patterns in bullous pemphigoid, epidermolysis bullosa acquisita, and bullous lupus: A retrospective observational study. J Am Acad Dermatol 2024:S0190-9622(24)00374-8. [PMID: 38368951 DOI: 10.1016/j.jaad.2024.01.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 11/17/2023] [Accepted: 01/10/2024] [Indexed: 02/20/2024]
Affiliation(s)
- Catherine S Barker
- Department of Internal Medicine, Medical University of South Carolina, Charleston, South Carolina.
| | - Evelyn Bruner
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Sally Self
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Dirk M Elston
- Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina, Charleston, South Carolina
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3
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Muzumdar S, Bibb LA, Sloan B, Murphy M, Chang MW. Letter in reply: Linear IgA bullous dermatosis treated with dupilumab in a pediatric patient with glucose-6-phosphate dehydrogenase deficiency. JAAD Case Rep 2024; 44:44-46. [PMID: 38292583 PMCID: PMC10825298 DOI: 10.1016/j.jdcr.2023.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024] Open
Affiliation(s)
- Sonal Muzumdar
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut
| | - Lorin A. Bibb
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Brett Sloan
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut
| | - Michael Murphy
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut
| | - Mary Wu Chang
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut
- Department of Pediatrics, University of Connecticut Health Center, Farmington, Connecticut
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4
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Bawany F, Ramachandran V, Rodriguez E, Kim RH, Weber JS, Tattersall IW. Linear IgA bullous dermatosis induced by nemvaleukin alfa, an engineered interleukin 2 molecule, in a patient with treatment-refractory metastatic melanoma. JAAD Case Rep 2023; 41:7-9. [PMID: 37842150 PMCID: PMC10568223 DOI: 10.1016/j.jdcr.2023.08.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Affiliation(s)
- Fatima Bawany
- Department of Dermatology, New York University, New York, New York
| | | | | | - Randie H. Kim
- Department of Dermatology, New York University, New York, New York
| | - Jeffrey S. Weber
- Department of Medical Oncology, New York University, New York, New York
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5
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Khan S, Bae E, Mathieu RJ, Elco C, Massoud CM, Firoz EF. Revisiting the "jelly-roll" technique: New utility in diagnosing linear IgA bullous dermatosis mimicking toxic epidermal necrolysis. JAAD Case Rep 2023; 41:75-76. [PMID: 37877093 PMCID: PMC10590713 DOI: 10.1016/j.jdcr.2023.08.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023] Open
Affiliation(s)
- Samavia Khan
- Department of Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey
| | - Edward Bae
- Department of Dermatology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Regine J. Mathieu
- Department of Dermatology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Christopher Elco
- Department of Dermatology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Pathology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Cathy M. Massoud
- Department of Dermatology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Pathology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Elnaz F. Firoz
- Department of Dermatology, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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6
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Libson K, Koenig KL, Chung CG, Korman AM. Development of cyclosporine-induced linear IgA bullous dermatosis despite concurrent use of dapsone. JAAD Case Rep 2023; 40:74-76. [PMID: 37731671 PMCID: PMC10507066 DOI: 10.1016/j.jdcr.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023] Open
Affiliation(s)
- Karissa Libson
- Ohio State University College of Medicine, Columbus, Ohio
| | - Kristin L. Koenig
- Department of Hematology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Catherine G. Chung
- Department of Pathology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Abraham M. Korman
- Department of Dermatology, Ohio State University Wexner Medical Center, Columbus, Ohio
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7
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Jing K, Wang Y, Li S, Feng S. IgA autoantibody may be the foremost pathogenic in three cases of linear IgA/IgG bullous dermatosis. Australas J Dermatol 2023; 64:e224-e228. [PMID: 37403826 DOI: 10.1111/ajd.14114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 05/22/2023] [Accepted: 06/12/2023] [Indexed: 07/06/2023]
Abstract
Linear IgA/IgG bullous dermatosis (LAGBD) is a relatively rare autoimmune bullous disease characterized by both IgA and IgG antibodies to basement membrane zone. The heterogeneity and pathogenesis of antibodies and the relationship between IgA and IgG in LAGBD have not been fully elucidated. We observed clinical, histological and immunological features of three LAGBD cases at different time points in the disease course. In our cohort, two cases showed IgA antibodies to epidermal antigens vanished when their lesions cleared after 3 months of treatment. One refractory case showed increasing antigens targeted by IgA antibodies with the progression of the disease. Collectively, the results suggest that IgA antibodies may play a major role in LAGBD. In addition, epitope spreading may be related to disease relapse and treatment refractory.
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Affiliation(s)
- Ke Jing
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Yuan Wang
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Suo Li
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Suying Feng
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
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8
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Ramos MA, Cruz-Regalado JM, Bernales-Mendoza AM, Ramilo V. A case of linear IgA bullous dermatosis in a glucose-6-phosphate dehydrogenase-deficient child successfully treated with oral erythromycin and topical tacrolimus. JAAD Case Rep 2023; 32:102-5. [PMID: 36876037 DOI: 10.1016/j.jdcr.2022.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
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9
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Andriano TM, Tannenbaum R, Xu H, Magro CM. Linear IgA bullous dermatosis in the setting of angioimmunoblastic T-cell lymphoma. J Cutan Pathol 2023; 50:43-46. [PMID: 35942597 DOI: 10.1111/cup.14309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 01/03/2023]
Abstract
We report an 80-year-old male developing linear IgA bullous dermatosis (LAD) in the setting of angioimmunoblastic T-cell lymphoma (AITL). This phenomenon is rare, as only three cases have been described in the literature. The pathophysiologic process can be attributed to dysregulation in somatic hypermutation and the expression of chemokine receptor 5 in AITL, contributing to increased IgA. Immunoglobulin production resulting from clonal plasma cell expansion may be because of the B-cell promotional effect by neoplastic follicular helper T-cells. Beyond providing a pathophysiologic platform for AITL-associated LAD, we also briefly summarized prior cases. This report demonstrates the importance of considering LAD in the differential diagnosis for patients with a bullous eruption in the setting of AITL.
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Affiliation(s)
| | - Rachel Tannenbaum
- Donald and Barbara Zucker Northwell School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Haoming Xu
- Department of Dermatology, Weill Cornell Medicine, New York, New York, USA
| | - Cynthia M Magro
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA
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10
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Drnovšek-Olup B, Matović K. Localized Linear IgA Bullous Dermatosis and a Recurrent Cicatricial Ectropion of the Eyelid: A Case Report of a Sixteen-Year Follow-up. Indian J Dermatol 2022; 67:835. [PMID: 36998840 PMCID: PMC10043643 DOI: 10.4103/ijd.ijd_909_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
Abstract
Cicatrizing ectropion of the eyelid is an uncommon condition, possibly resulting in significant ocular morbidity. A potential cause can be a systemic disease, including autoimmune blistering disease (ABD). We herein report a case with a sixteen-year follow-up of a patient with a chronic cicatrizing unilateral ectropion caused by linear IgA bullous dermatosis (LABD). LABD is an ABD, characterized by the accumulation of IgA anti-basement membrane autoantibodies. It has a varied presentation; however, localized or ophthalmic manifestations have been infrequently described. The case demonstrates the benefits of immunohistochemistry in obtaining the correct diagnosis, and difficulties in the medical and surgical management of a recurrent cicatricial ectropion caused by chronic systemic disease.
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Affiliation(s)
| | - Katja Matović
- From the Eye Hospital, University Medical Centre Ljubljana, Slovenia
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11
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Nahm WJ, Juarez M, Wu J, Kim RH. Eosinophil-rich linear IgA bullous dermatosis induced by mRNA COVID-19 booster vaccine. J Cutan Pathol 2022; 50:24-28. [PMID: 35922892 PMCID: PMC9538274 DOI: 10.1111/cup.14305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 07/09/2022] [Accepted: 08/01/2022] [Indexed: 01/03/2023]
Abstract
We present a case of eosinophil-rich linear IgA bullous disease (LABD) following the administration of a messenger RNA COVID-19 booster vaccine. A 66-year-old man presented to the emergency department with a 3-week history of a pruritic blistering rash characterized by fluid-filled bullae and multiple annular and polycyclic plaques. He was initially diagnosed with bullous pemphigoid based on a biopsy showing a subepidermal blister with numerous eosinophils. However, direct immunofluorescence studies showed linear IgA and IgM deposition along the basement membrane zone with no immunoreactivity for C3 or IgG. Additionally, indirect immunofluorescence was positive for IgA basement membrane zone antibody. The patient was subsequently diagnosed with LABD and initiated on dapsone therapy with resolution of his lesions at 3-month follow-up. This case illustrates the growing number of autoimmune blistering adverse cutaneous reactions from vaccination. Dermatopathologists should be aware that features of autoimmune blistering diseases can overlap and may not be distinguishable based on these histopathological findings alone. Confirmation with direct immunofluorescence and/or serological studies may be necessary for accurate diagnosis.
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Affiliation(s)
- William J. Nahm
- The Ronald O. Perelman Department of DermatologyNYU Grossman School of MedicineNew YorkNew YorkUSA
| | - Michelle Juarez
- The Ronald O. Perelman Department of DermatologyNYU Grossman School of MedicineNew YorkNew YorkUSA
| | - Julie Wu
- The Ronald O. Perelman Department of DermatologyNYU Grossman School of MedicineNew YorkNew YorkUSA
| | - Randie H. Kim
- The Ronald O. Perelman Department of DermatologyNYU Grossman School of MedicineNew YorkNew YorkUSA
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12
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Tekin B, Johnson EF, Wieland CN, Gibson LE, Camilleri MJ, Kalaaji AN, Comfere NI, Peters MS, Lehman JS. Histopathology of autoimmune bullous dermatoses: What's new? Hum Pathol 2022; 128:69-89. [PMID: 35764145 DOI: 10.1016/j.humpath.2022.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/19/2022] [Accepted: 06/21/2022] [Indexed: 11/25/2022]
Abstract
Autoimmune bullous dermatoses are characterized by the presence of tissue-bound and often circulating pathogenic autoantibodies targeting structural components of the skin and/or mucous membranes. The diagnostic workup for this heterogeneous group of disorders consists of a multi-step process, of which the light microscopic examination is a crucial component. This review is organized following a classification scheme that is based on two main histopathologic features, namely level of intraepithelial split and composition of the inflammatory infiltrate. Overall, we aim to place emphasis on the histopathologic clues that can assist pathologists in differential diagnosis and review the updates in the literature.
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Affiliation(s)
- Burak Tekin
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Emma F Johnson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA; Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Carilyn N Wieland
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA; Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Lawrence E Gibson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA; Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Michael J Camilleri
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA; Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Amer N Kalaaji
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA; Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Nneka I Comfere
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA; Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Margot S Peters
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA; Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Julia S Lehman
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA; Department of Dermatology, Mayo Clinic, Rochester, MN, USA.
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13
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Haulrig MB, Nielsen SL, Elberling J, Skov L. Linear IgA/IgG bullous dermatosis successfully treated with omalizumab: A case report. Clin Case Rep 2022; 10:e05368. [PMID: 35280104 PMCID: PMC8905130 DOI: 10.1002/ccr3.5368] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/10/2021] [Accepted: 01/19/2022] [Indexed: 11/26/2022] Open
Abstract
Linear IgA/IgG bullous dermatosis (LAGBD) is a rare, autoimmune blistering skin disease. We report a case of LAGBD in a 70-year-old woman. All common treatments were discontinued due to side effects or lack of treatment response. The patient was successfully treated with omalizumab which cleared her lesions after three months.
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Affiliation(s)
- Morten Bahrt Haulrig
- Department of Dermatology and AllergyHerlev and Gentofte HospitalUniversity of CopenhagenHellerupDenmark
| | - Signe Ledou Nielsen
- Department of Pathology, Herlev and Gentofte HospitalUniversity of CopenhagenHerlevDenmark
| | - Jesper Elberling
- Department of Dermatology and AllergyHerlev and Gentofte HospitalUniversity of CopenhagenHellerupDenmark
| | - Lone Skov
- Department of Dermatology and AllergyHerlev and Gentofte HospitalUniversity of CopenhagenHellerupDenmark
- Copenhagen Research Group for Inflammatory Skin (CORGIS)HellerupDenmark
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14
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Corrà A, Bonciolini V, Quintarelli L, Verdelli A, Caproni M. Linear IGA bullous dermatosis potentially triggered by vaccination. Int J Immunopathol Pharmacol 2022; 36:20587384211021218. [PMID: 35001680 PMCID: PMC8753231 DOI: 10.1177/20587384211021218] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 05/06/2021] [Indexed: 11/16/2022] Open
Abstract
Linear IgA bullous dermatosis (LABD) is a mucocutaneous autoimmune blistering disease affecting both adults and children. It is caused by IgA antibodies targeting multiple antigens along the basement membrane zone, leading to disruption of dermoepidermal junction and development of bullous lesions which often presents in characteristic arrangement. Although most LABD cases have been reported to be idiopathic, different triggers have been described, including several drugs and infection. However, the occurrence of vaccine-induced cases of LABD is not widely known and accepted due to the few reports available. We present two cases of LABD occurred following different triggers, rising the suspicion for a possible pathogenetic role of vaccines.
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Affiliation(s)
- Alberto Corrà
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Veronica Bonciolini
- Dermatology Unit, Versilia Hospital, USL Toscana Nord-Ovest, Lido di Camaiore, Lucca, Italy
| | - Lavinia Quintarelli
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Alice Verdelli
- Department of Experimental and Clinical Biomedical Sciences ‘Mario Serio’, University of Florence, Florence, Italy
| | - Marzia Caproni
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
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15
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Abstract
Although relatively uncommon, autoimmune bullous diseases carry the risk of increased mortality and can significantly impact quality of life. This group of diseases is broad and encompasses subepidermal conditions like bullous pemphigoid, cicatricial pemphigoid, epidermolysis bullosa acquisita, dermatitis herpetiformis, and linear IgA bullous dermatosis, as well as intraepidermal conditions like pemphigus and its variants. The pathophysiology of each condition is incompletely understood but broadly involves the formation of autoantibodies targeting skin adhesion proteins, a process which relies on a complex interplay between a dysregulated immune system, genetic predisposition, and environmental factors. We review the impact of nutrition on pathogenesis, clinical course, and treatment of various autoimmune bullous diseases.
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Affiliation(s)
- Amber Jimenez
- University of Utah School of Medicine, Salt Lake City, Utah
| | - Christina Topham
- Department of Dermatology, University of Utah, Salt Lake City, Utah
| | - Danny Varedi
- Department of Dermatology, University of Utah, Salt Lake City, Utah
| | | | - Christopher Hull
- Department of Dermatology, University of Utah, Salt Lake City, Utah
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17
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Shin L, Gardner JT 2nd, Dao H Jr. Updates in the Diagnosis and Management of Linear IgA Disease: A Systematic Review. Medicina (Kaunas) 2021; 57:818. [PMID: 34441024 DOI: 10.3390/medicina57080818] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/04/2021] [Accepted: 08/10/2021] [Indexed: 11/29/2022]
Abstract
Background and Objectives: Linear IgA disease (LAD) is a rare autoimmune blistering disease with linear IgA deposits along the basement membrane zone. Direct immunofluorescence remains the gold standard for diagnosis, but other diagnostic measures reported in recent literature have proven useful in the setting of inconclusive preliminary results. Dapsone is a commonly used treatment, but many therapeutic agents have emerged in recent years. The objective of this study is to provide a comprehensive overview of updates on the diagnosis and management of LAD. Materials and Methods: A literature search was conducted from May to June of 2021 for articles published in the last 5 years that were related to the diagnosis and management of LAD. Results: False-negative results in cases of drug-induced LAD and the presence of IgG and IgM antibodies on immunofluorescence studies were reported. Serration pattern analysis has been reported to be useful in distinguishing LAD from sublamina densa-type LAD. Rituximab, omalizumab, etanercept, IVIg, sulfonamides, topical corticosteroids, and others have been used successfully in adult and pediatric patients with varying disease severity. Topical corticosteroids were preferred for pediatric patients while rituximab and IVIg were used in adults with recalcitrant LAD. Sulfonamides were utilized in places without access to dapsone. Conclusion: In cases where preliminary biopsy results are negative and clinical suspicion is high, repeat biopsy and additional diagnostic studies should be used. Patient factors such as age, medical comorbidities, and disease severity play a role in therapeutic selection.
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18
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Yoshida K, Yoshihama E, Morii K, Ishiko A. Blister fluid is a useful diagnostic tool for diagnosis of vancomycin-induced linear IgA bullous dermatosis. J Dermatol 2021; 48:e543-e544. [PMID: 34368986 DOI: 10.1111/1346-8138.16105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/08/2021] [Accepted: 07/25/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Kenji Yoshida
- Faculty of Medicine, Department of Dermatology, Toho University School of Medicine, Tokyo, Japan
| | - Eri Yoshihama
- Faculty of Medicine, Department of Dermatology, Toho University School of Medicine, Tokyo, Japan
| | - Kaya Morii
- Faculty of Medicine, Department of Dermatology, Toho University School of Medicine, Tokyo, Japan
| | - Akira Ishiko
- Faculty of Medicine, Department of Dermatology, Toho University School of Medicine, Tokyo, Japan
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19
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Montagnon CM, Lehman JS, Murrell DF, Camilleri MJ, Tolkachjov SN. Subepithelial autoimmune bullous dermatoses disease activity assessment and therapy. J Am Acad Dermatol 2021; 85:18-27. [PMID: 33684494 DOI: 10.1016/j.jaad.2020.05.161] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/17/2020] [Accepted: 05/21/2020] [Indexed: 12/18/2022]
Abstract
Subepidermal (subepithelial) autoimmune blistering dermatoses are a group of rare skin disorders characterized by the disruption of the dermal-epidermal junction through the action of autoantibodies. The fourth article in this continuing medical education series presents the current validated disease activity scoring systems, serologic parameters, treatments, and clinical trials for bullous pemphigoid, mucous membrane pemphigoid, epidermolysis bullosa acquisita, bullous systemic lupus erythematosus, anti-p200 pemphigoid, linear IgA bullous dermatosis, and dermatitis herpetiformis.
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Affiliation(s)
| | - Julia S Lehman
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Dedee F Murrell
- Department of Dermatology, St George Hospital, University of New South Wales, Sydney, Australia
| | - Michael J Camilleri
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
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20
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Montagnon CM, Tolkachjov SN, Murrell DF, Camilleri MJ, Lehman JS. Subepithelial autoimmune blistering dermatoses: Clinical features and diagnosis. J Am Acad Dermatol 2021; 85:1-14. [PMID: 33684496 DOI: 10.1016/j.jaad.2020.11.076] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 11/01/2020] [Accepted: 11/02/2020] [Indexed: 01/19/2023]
Abstract
Subepithelial autoimmune blistering dermatoses are a group of rare skin disorders that are characterized by the disruption of the dermal-epidermal junction through the action of autoantibodies. The third article in this continuing medical education series explores the background, epidemiology, clinical features, and diagnostic criteria of each of the major subepithelial autoimmune blistering dermatoses, including bullous pemphigoid, pemphigoid gestationis, lichen planus pemphigoides, mucous membrane pemphigoid, linear IgA bullous dermatosis, and dermatitis herpetiformis.
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Verdelli A, Caproni M. Comment on "Dermatitis herpetiformis in an African woman", the importance of direct immunofluorescence assay. Pan Afr Med J 2020; 36:196. [PMID: 32952840 PMCID: PMC7467610 DOI: 10.11604/pamj.2020.36.196.18397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 12/16/2019] [Indexed: 11/24/2022] Open
Affiliation(s)
- Alice Verdelli
- Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Florence, Italy
| | - Marzia Caproni
- U.O. Dermatology I, P.O. Piero Palagi, USL Toscana Centro, University of Florence, Florence, Italy
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Yang Z, Liu ZH, Sun CQ, Shen H. Successful treatment of a case of idiopathic linear IgA bullous dermatosis with oral sulfasalazine. Dermatol Ther 2020; 33:e13210. [PMID: 31895494 DOI: 10.1111/dth.13210] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 12/12/2019] [Accepted: 12/26/2019] [Indexed: 11/30/2022]
Abstract
Linear IgA bullous dermatosis (LABD) is a rare acquired autoimmune chronic vesiculobullous dermatosis affecting primarily young children and older adults. We report a 17-year-old Chinese boy with a 2-month history of intense itching erythema or tense vesicles on healthy skin or on an erythematous base, with parts of lesions arising a characteristic "cluster of jewels" pattern. With the characteristics of vesicles or blisters on the skin, subepidermal blisters with neutrophilic infiltrate on histology, and linear IgA deposits on the basement membrane zone and absence of other immunoglobulins on direct immunofluorescence, LABD was dignosized. Sulfapyridine has also been reported as one of the best options of systemic therapy for LABD. Our patient successfully treated with only oral sulfasalazine (alternative medicine of sulfasalazine), which is safe and effective.
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Affiliation(s)
- Zhen Yang
- Department of Dermatology, Affiliated Hangzhou Third Hospital, Anhui Medical University, Hangzhou, China
| | - Ze-Hu Liu
- Department of Dermatology, Affiliated Hangzhou Third Hospital, Anhui Medical University, Hangzhou, China
| | - Chun-Qiu Sun
- Department of Dermatology, Affiliated Hangzhou Third Hospital, Anhui Medical University, Hangzhou, China
| | - Hong Shen
- Department of Dermatology, Affiliated Hangzhou Third Hospital, Anhui Medical University, Hangzhou, China
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Kanda N, Nakadaira N, Otsuka Y, Ishii N, Hoashi T, Saeki H. Linear IgA bullous dermatosis associated with ulcerative colitis: A case report and literature review. Australas J Dermatol 2019; 61:e82-e86. [PMID: 31319433 DOI: 10.1111/ajd.13121] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 06/24/2019] [Indexed: 11/27/2022]
Abstract
We report the case of a 59-year-old Japanese woman who developed linear IgA bullous dermatosis during treatment for ulcerative colitis that manifested as pruritic vesicles with erythema on the trunk and scalp. Histopathological examination revealed subepidermal bulla with neutrophil and eosinophil infiltration in the upper dermis. Direct immunofluorescence revealed linear IgA deposits at the basement membrane zone, and indirect immunofluorescence using split skin revealed IgA reaction to the epidermal side (lamina lucida type). We reviewed 33 reported cases of linear IgA bullous dermatosis associated with ulcerative colitis and found that ulcerative colitis preceded the onset of linear IgA bullous dermatosis in 94% of the patients and that IgA-positive patients in split skin indirect immunofluorescence all showed the lamina lucida type, indicating that target antigens for serum IgA antibodies may reside in the lamina lucida. Regarding the pathogenetic association of ulcerative colitis and linear IgA bullous dermatosis, intestinal inflammation may induce the exposure and presentation of intestinal antigens that are cross-reactive to cutaneous antigens, stimulating autoimmune response to antigens of cutaneous basement membrane zones.
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Affiliation(s)
- Naoko Kanda
- Department of Dermatology, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Chiba
| | - Nanami Nakadaira
- Department of Dermatology, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Chiba
| | - Yohei Otsuka
- Department of Dermatology, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Chiba
| | - Norito Ishii
- Department of Dermatology, Kurume University School of Medicine, Fukuoka
| | | | - Hidehisa Saeki
- Department of Dermatology, Nippon Medical School, Tokyo, Japan
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25
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Visentainer L, Massuda JY, Cintra ML, Magalhães RF. Vancomycin-induced linear IgA bullous dermatosis (LABD)-an atypical presentation. Clin Case Rep 2019; 7:1091-1093. [PMID: 31110752 PMCID: PMC6509886 DOI: 10.1002/ccr3.2039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 11/26/2018] [Accepted: 12/04/2018] [Indexed: 11/15/2022] Open
Abstract
We report an uncommon presentation of bullous dermatosis by linear IgA. There are few cases reported in the literature with this form of presentation starting with mucosal lesions and then evolving into a similar bullous pemphigoid pattern. In addition, we emphasize the importance of direct immunofluorescence for the definitive diagnosis.
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Garel B, Ingen-Housz-Oro S, Afriat D, Prost-Squarcioni C, Tétart F, Bensaid B, Bara Passot C, Beylot-Barry M, Descamps V, Duvert-Lehembre S, Grootenboer-Mignot S, Jeudy G, Soria A, Valnet-Rabier MB, Barbaud A, Caux F, Lebrun-Vignes B. Drug-induced linear immunoglobulin A bullous dermatosis: A French retrospective pharmacovigilance study of 69 cases. Br J Clin Pharmacol 2019; 85:570-579. [PMID: 30511379 DOI: 10.1111/bcp.13827] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 11/08/2018] [Accepted: 11/23/2018] [Indexed: 11/27/2022] Open
Abstract
AIMS Linear immunoglobin A (IgA) bullous dermatosis is a rare autoimmune dermatosis considered spontaneous or drug-induced (DILAD). We assessed all DILAD cases, determined the imputability score of drugs and highlighted suspected drugs. METHODS Data for patients with DILAD were collected retrospectively from the French Pharmacovigilance network (from 1985 to 2017) and from physicians involved in the Bullous Diseases French Study Group and the French Investigators for Skin Adverse Reactions to Drugs. Drug causality was systematically determined by the French imputability method. RESULTS Of the 69 patients, 42% had mucous membrane involvement, 20% lesions mimicking toxic epidermal necrolysis (TEN), 21% eosinophil infiltrates and 10% keratinocytes necrosis. Direct immunofluorescence, in 80%, showed isolated linear IgA deposits. Vancomycin (VCM) was suspected in 39 cases (57%), 11 had TEN-like lesions, as compared with three without VCM suspected. Among the 33 patients with a single suspected drug, 85% had an intrinsic imputability score of I4. Among them, enoxaparin, minocycline and vibramycin were previously unpublished. For all patients, the suspect drug was withdrawn; 15 did not receive any treatment. First-line therapy for 31 patients was topical steroids. Among the 60 patients with available follow-up, 52 achieved remission, 10 without treatment. Four patients experienced relapse, four died and five had positive accidental rechallenges. CONCLUSIONS There is no major clinical difference between DILAD and idiopathic linear IgA bullous dermatosis, but the former features a higher prevalence of patients mimicking TEN. VCM, suspected in more than half of the cases, might be responsible for more severe clinical presentations. We report three new putative drugs.
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Affiliation(s)
- Bethsabée Garel
- Department of Dermatology, Assistance Publique-Hôpitaux de Paris (APHP), Henri-Mondor Hospital, 94010, Créteil, France
| | - Saskia Ingen-Housz-Oro
- Department of Dermatology, Assistance Publique-Hôpitaux de Paris (APHP), Henri-Mondor Hospital, 94010, Créteil, France.,EA 7379 EpiDermE, Université Paris Est Créteil Val de Marne UPEC, Créteil, France.,Reference Center for toxic bullous diseases and severe drug reactions, Créteil, France
| | - Daniele Afriat
- Regional Center of Pharmacovigilance, APHP, Pitié-Salpêtrière Hospital, Paris, France
| | - Catherine Prost-Squarcioni
- Dermatology Department, APHP, Avicenne Hospital, Bobigny, France.,Pathology Department, APHP, Avicenne Hospital, Bobigny, France.,Université Paris 13, Bobigny, France
| | - Florence Tétart
- Department of Dermatology, Rouen University Hospital, Rouen, France
| | - Benoit Bensaid
- Drug Allergy Unit-CCR2A, Department of Allergy and Clinical Immunology, CHU Lyon-Sud, Pierre Benite, France
| | | | - Marie Beylot-Barry
- Department of Dermatology, Bordeaux University Hospital, Bordeaux, France
| | - Vincent Descamps
- Department of Dermatology, APHP, Bichat Claude Bernard Hospital, Paris Diderot University
| | | | | | - Géraldine Jeudy
- Department of Dermatology, Dijon University Hospital, Dijon, France
| | - Angèle Soria
- Department of Dermatology and Allergology, APHP, Tenon Hospital, Paris, France.,Sorbonne Université, Faculté de Médecine Sorbonne Université, Paris, France.,Inserm, UMR 1135, Paris, France
| | | | - Annick Barbaud
- Reference Center for toxic bullous diseases and severe drug reactions, Créteil, France.,Department of Dermatology and Allergology, APHP, Tenon Hospital, Paris, France.,Sorbonne Université, Faculté de Médecine Sorbonne Université, Paris, France
| | - Frédéric Caux
- Dermatology Department, APHP, Avicenne Hospital, Bobigny, France.,Université Paris 13, Bobigny, France
| | - Bénédicte Lebrun-Vignes
- EA 7379 EpiDermE, Université Paris Est Créteil Val de Marne UPEC, Créteil, France.,Reference Center for toxic bullous diseases and severe drug reactions, Créteil, France.,Regional Center of Pharmacovigilance, APHP, Pitié-Salpêtrière Hospital, Paris, France
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Rainey A, Auerbach J, Shah K. Non-infectious diffuse vesiculobullous rash in a pancreas and renal transplant recipient. Transpl Infect Dis 2018; 20:e12990. [PMID: 30184311 DOI: 10.1111/tid.12990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 08/17/2018] [Accepted: 08/26/2018] [Indexed: 11/28/2022]
Abstract
Solid organ transplant patients are well established to be at risk of herpes simplex virus and varicella zoster virus infection and reactivation. We present a case of a 41-year-old woman with a history of pancreas and renal transplant who presented with what appeared to be disseminated herpes simplex virus or varicella zoster virus induced rash, but who was ultimately diagnosed and treated as linear IgA bullous dermatosis. This case alerts physicians to other non-infectious dermatoses as a cause of vesiculobullous rash in solid organ transplant patients.
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Affiliation(s)
- Anthony Rainey
- Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida
| | - Jena Auerbach
- Department of Pathology Immunology, and Laboratory Medicine, College of Medicine, University of Florida, Gainesville, Florida
| | - Kairav Shah
- Department of Medicine, Division of Infectious Diseases & Global Medicine, College of Medicine, University of Florida, Gainesville, Florida
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Valenzuela Ahumada F, Bustos Macaya R, Romero Morgado GP, Sánchez Chacón M. Linear immunoglobulin A dermatosis: A case report. Medwave 2017; 17:e6901. [PMID: 28430766 DOI: 10.5867/medwave.2017.03.6901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 01/26/2017] [Indexed: 11/27/2022] Open
Abstract
We present the case of a sixty five year old woman with two months history of pruritus and hyperpigmented annular lesions on the trunk, buttocks and upper extremities. In addition, she presents vesicles with healthy skin on the basis, in the flexor aspect of wrists. No evidence of mucosal involvement. Histological study showed subepidermal vesicular dermatitis with inflammatory infiltrate of neutrophils and eosinophils. Direct immunofluorescence evidenced linear and continuous deposition of immunoglobulin A in basement membrane zone, compatible with linear immunoglobulin A disease.
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Affiliation(s)
- Fernando Valenzuela Ahumada
- Facultad de Medicina, Universidad de Chile, Santiago, Chile. Address: Departamento de Dermatología, Hospital Clínico Universidad de Chile, Santos Dumont 999, Independencia, Santiago, Chile .
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Tiger JB, Rush JT, Barton DT, Danilov AV, Chapman MS. Urticarial linear IgA bullous dermatosis (LABD) as a presenting sign of chronic lymphocytic leukemia (CLL). JAAD Case Rep 2015; 1:412-4. [PMID: 27051795 PMCID: PMC4809402 DOI: 10.1016/j.jdcr.2015.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Jeffrey B Tiger
- Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Jessica T Rush
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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Affiliation(s)
- Catherine S Yang
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Leslie Robinson-Bostom
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Shoshana Landow
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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