A case of vancomycin-associated linear IgA bullous dermatosis and IgA antibodies to the α3 subunit of laminin-332

Abstract

Linear IgA bullous dermatosis (LABD) is a rare autoimmune bullous disease, which is defined by the histopathological finding of subepidermal vesicles with neutrophilic infiltration and linear IgA deposits in the basement membrane zone, revealed by immunofluorescence study. We present a case of LABD in which vancomycin (VCM) administration triggered LABD, and immunoblot analysis showed IgA antibodies reactive to the 145- and 165-kDa α3 subunits of laminin-332. This is the first report of VCM-associated LABD in which the target antigen was laminin-332. In the present case, we were compelled to continue administration of VCM along with systemic steroids, which eventually led to the attenuation of the symptoms, normalization of the serum IgA level, and negative results on both indirect immunofluorescence of 1 mol L(-1) NaCl-split skin and immunoblot analysis.

Linear immunoglobulin A/immunoglobulin G bullous dermatosis with autoantibodies to LAD-1 and laminin-γ1

“…To our knowledge, only seven patients with LAGBD with multiple autoantibodies have been reported previously (Table ) . Most of these cases showed reactivity with laminin‐332 and/or BP180.…”

Glycopeptide Hypersensitivity and Adverse Reactions

“…Clinically characterized by the appearance of multiple small itchy bullae within annular erythema on the entire body, LABD risk factors include male sex and age greater than 68. Skin lesions typically appear 1 to 21 days upon receipt of vancomycin, and symptoms typically disappear after vancomycin is discontinued, but it can take up to 60 days for complete resolution [23]. Diagnosis of LABD may be complicated and difficult to differentiate from other severe cutaneous reactions as 42% of patients have mucosal involvement, 20% have lesions mimicking TEN, and 21% have eosinophil infiltrates [49].…”

“…Life-threatening immunoglobulin E (IgE)-mediated allergic reactions to vancomycin are rare; however, true allergic reactions may be mistaken for RMS given the overlap in clinical presentation, leading to confusion, incorrectly challenging patients with true IgE-mediated reaction, or the use of alternative agents such as daptomycin or linezolid in patients who experience RMS. Other immune-mediated reactions, such as linear immunoglobulin A (IgA) bullous dermatosis (LABD), Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN), have also been observed with vancomycin use [21][22][23]. Hypersensitivity reactions are summarized based on the type in Table 1.…”

Piperacillin-tazobactam-induced linear IgA bullous dermatosis presenting clinically as Stevens-Johnson syndrome/toxic epidermal necrolysis overlap

“…To date, there have been six published case reports describing LABD following exposure to vancomycin and piperacillin–tazobactam in combination, all of which implicated vancomycin as the main culprit . Of the penicillin antibiotics, only aminopenicillins have been previously implicated in LABD .…”