Bullous eruption in a five-month-old girl

Khaled, A.; Kharfi, Monia; Fazaa, B.; Kamoun, Mohamed Ridha

doi:10.1503/cmaj.090867

Cited by 6 publications

(6 citation statements)

References 10 publications

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“…The correlation between vaccination and autoimmune disease was previously suggested in diseases such as systemic sclerosis, chronic fatigue syndrome, fibromyalgia, transverse myelitis [33] systemic lupus erythematosus [44], anti-phospholipid syndrome, Guillain-Barré syndrome, Crohn's disease, macrophagic myofasciitis, vasculitis, myelitis vaccinations and etc [45][46][47][48][49][50][51]. The same association was suggested for childhood and infantile BP [19][20][21][22][23][24][25][26][27][28][29][30][31].…”

Section: Discussionmentioning

confidence: 77%

“…In addition there are reports proposing the correlation of BP and vaccinations in adults [10][11][12][13][14][15][16][17][18] and young children (Table 1) [19][20][21][22][23][24][25][26][27][28][29][30][31]. The most common types of preceding vaccinations were influenza vaccines and the diphtheria tetanus pertussis but there are few reports on bullous pemphigoid following hepatitis B vaccination.…”

Section: Introductionmentioning

confidence: 99%

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Infantile Bullous Pemphigoid Following Hepatitis B Vaccinations

Alex¹

2014

Immunome Res

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The development of infantile and childhood bullous pemphigoid following vaccination was already documented in several cases. This post-vaccination autoimmune phenomenon is part of the autoimmune/inflammatory syndrome induced by adjuvants (ASIA).A 4 months old female patient, presented with bullous skin rash, two months following her second inoculation with the hepatitis B vaccine (HBVv). In addition, during the appearance of the rash she received the second dose of hexavalent INFANRIX™-IPV/Hib vaccine (GSK), which was followed by irritability and fever. According to the clinical picture, biopsy result, direct immune fluorescent (DIF) and indirect immune fluorescent (IIF), a diagnosis of infantile bullous pemphigoid (BP) was determined. The patient was resistant to most conventional therapies.We report a case of an infantile BP, which appeared following immunization with HBVv. This case depicts a temporal association between the appearance of autoimmune diseases and vaccines. The appearance of bullous dermatoses following vaccinations was reported in 14 case reports. The physicians should be aware of the option of such link and further inquiry is warranted.

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Section: Discussionmentioning

confidence: 77%

Section: Introductionmentioning

confidence: 99%

Infantile Bullous Pemphigoid Following Hepatitis B Vaccinations

Alex¹

2014

Immunome Res

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“…Garcia-Doval et al 32 did not find an increased incidence of BP in people 65 years or older following an influenza vaccine, but in 2 of the reported cases of postvaccination BP (1 infant and 1 adult) the patients developed a relapse of BP after having received an additional vaccination. 4,18 In another case, no recurrence of BP was observed following readministration of the Tetracoq vaccine, 1 year after the initial development of BP. 3 Bullous pemphigoid developing after vaccination is likely to be a rare event among vaccinated individuals, or the relationship might be serendipitous.…”

Section: Discussionmentioning

confidence: 97%

Anti–Laminin-332 Mucous Membrane Pemphigoid Developing After a Diphtheria Tetanus Vaccination

et al. 2013

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accine administration is an effective tool to prevent infectious diseases, but its powerful stimulus on the immune system has generated the fear of exacerbating preexisting autoimmune diseases or inducing autoimmune disorders in otherwise healthy individuals.1 Bullous pemphigoid (BP) is the most frequent autoimmune blistering skin disease. It affects predominantly elderly individuals but has also been reported in children. The etiologic characteristics of BP are unknown, but there have been 26 BP cases suspected of having been induced by vaccinations (Table). [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] In all of the postvaccination BP cases in which immunoblotting and/or enzyme-linked immunosorbent assay (ELISA) studies were performed, the target antigens were found to be BP180 and/or BP230. 3,8,12,16,17 We report a unique case of mucous membrane pemphigoid (MMP) that developed acutely in a 29-yearold man 2 days after he received a diphtheria tetanus (DT) vaccination. The results of laboratory studies were compatible with anti-laminin-332 MMP, which to our knowledge has not been previously described following vaccination. Report of a CaseAn otherwise healthy 29-year-old man was admitted to our department as a result of a sudden mucocutaneous eruption of blisters that occurred 2 days after receiving a DT vaccine for a traumatic skin cut. There were no available medical records of previous DT vaccinations, although the pediatric population in Israel is vaccinated regularly several times during childhood. The patient did not have a history of skin diseases or allergies to medications. The superficial cut was 1.5 cm long. It was treated with povidone-iodine solution and closed with adhesive surgical tape strips. There was no wound infection, and the patient did not receive any systemic antibiotics. On physical examination, there were tense blisters along with flaccid blisters and erosions on the face, inguinal area, and lower abdomen ( Figure 1). There were also widespread erosions on the oral mucosa (Figure 1). The Nikolsky sign was absent, and the rest of the physical examination had normal results. Histopathologic analysis of a skin blister revealed a subepidermal blister with complete epidermal-dermal separation and a sparse mononuclear cell infiltrate in the papillary dermis (Figure 2A and B). Immunohistochemical staining demonstrated type IV collagen on the dermal floor of the split ( Figure 2C). Direct immunofluorescence microscopy showed linear deposits of IgG and C3 along the basement membrane zone. An indirect immunofluorescence test on the patient's serum, which was performed on monkey esophagus, revealed linear deposits of IgG along the basement membrane zone with a titer of 1:160. Indirect immunofluorescence microscopy performed on 1M so-IMPORTANCE Bullous pemphigoid (BP) has been previously described to develop after vaccination in 26 patients. Immunoblotting or enzyme-linked immunosorbent assays (ELISAs), which were performed for 7 of these patients, have always shown circ...

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“…Unfortunately, many were animal research studies. Useful articles on the topic included one on bullous eruption in a 5-month old (Khaled, Kharfi, Fazaa, & Kamoun, 2010) and another on the increased risk of stroke in bullous pemphigoid patients (Yang, Chen, Xirasagar, & Lin, 2011).…”

Section: Full-text Journal Sourcesmentioning

confidence: 99%

Searching Online for Dermatology Resources

Young¹

2013

Journal of the Dermatology Nurses’ Association

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Dermatology nurses need access to evidencebased information to remain current in safe nursing practice. Many dermatology nurses do not have access to this information through medical library services. Searching online for free evidence-based dermatology information can be time consuming. This article reviews a wealth of free online international resources for this information. The article identifies databases, open-access journal resources, image databanks, and electronic books that have been made freely available by government agencies, professional societies, university medical centers, and commercial vendors.

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Bullous eruption in a five-month-old girl

Cited by 6 publications

References 10 publications

Infantile Bullous Pemphigoid Following Hepatitis B Vaccinations

Infantile Bullous Pemphigoid Following Hepatitis B Vaccinations

Anti–Laminin-332 Mucous Membrane Pemphigoid Developing After a Diphtheria Tetanus Vaccination

Searching Online for Dermatology Resources

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