Case Report: Variety of Target Antigens During 1 Year Follow-Up of a Patient Initially Diagnosed With Bullous Pemphigoid

Abstract

Autoimmune bullous diseases (AIBDs), presenting cutaneous and/or mucosal bullous lesions, are classified into pemphigus and pemphigoid diseases. A longtime observation for complicated AIBD cases is rarely reported. In this study, serum samples of one AIBD patient were collected at seven different time points during the disease course including a relapse, which were examined by our conventional and newly developed methods for the detection of autoantibodies. Interestingly, we found changes of both the presence and the titers of various autoantibodies in accordance with the changes of clinical features during the whole disease course, which indicated that the patient started as bullous pemphigoid and relapsed as concurrence of bullous pemphigoid and mucosal-dominant-type pemphigus vulgaris.

Case report: Mucous membrane pemphigoid with complicated autoantibody profile indicating the necessity of comprehensive diagnostic methods and the contribution of IgA autoantibodies

“…This case showed very complicated immunological profile of IgG and IgA autoantibodies to multiple autoantigens during the disease course, although this case might be simply diagnosed as bullous pemphigoid or anti-BP180-type MMP, if the comprehensive autoantibody screening was not performed. The results in this study emphasized the importance of comprehensive autoantibody screening with different immunoglobulin types for multiple time points ( 4 , 10 ).…”

Classification and Antigen Molecules of Autoimmune Bullous Diseases

“…With the disease progression, one subtype of AIBDs might shift to another subtype, or concur with other subtype(s) of AIBDs [ 75 , 76 ]. Therefore, during therapy, it is necessary to repeatedly test autoantibodies and autoantigens, which may suggest a change of treatment regimens.…”

Changes of platelet levels in routine blood tests may predict the possible remission and relapse of autoimmune bullous disease

“…Recently, we reported one patient with complicated autoimmune bullous diseases (AIBD), which occurred as bullous pemphigoid and reoccurred as bullous pemphigoid combined with mucosal‐dominant‐type pemphigus vulgaris 1 . Serum samples were collected from this patient for autoantibodies analyses at seven different time points including days 0, 7, 55, 105, 120, 270, and 279 after admission 1 .…”

“…Recently, we reported one patient with complicated autoimmune bullous diseases (AIBD), which occurred as bullous pemphigoid and reoccurred as bullous pemphigoid combined with mucosal‐dominant‐type pemphigus vulgaris 1 . Serum samples were collected from this patient for autoantibodies analyses at seven different time points including days 0, 7, 55, 105, 120, 270, and 279 after admission 1 . Finally, we found that the changes in titers of autoantibodies against BP230 recombinant protein (RP), BP180 NC16a RP, and desmoglein (Dsg) 1 LQ144 peptide (intracellular domain) were well matched with the changes in clinical features during the whole disease course including a relapse on day 270 1 …”

“…in clinical features during the whole disease course including a relapse on day 270. 1 In the present study, the levels of above three circulating IgG autoantibodies and some parameters in routine blood tests in the same AIBD patient were collected for correlation analyses at eight different time points, including the above-mentioned seven time points and an additional day 461.…”