Drug-Induced Linear IgA Bullous Dermatosis

Onodera, Hanae; Mihm, Martín C.; Yoshida, Aki; Akasaka, Toshihide

doi:10.1111/j.1346-8138.2005.tb00839.x

Cited by 51 publications

(37 citation statements)

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“…Several drugs have been implicated as the cause of LABD, vancomycin being the most frequent [6][7][8][9][10][11][12] . LABD can occur anytime from 1 day to 1 month following the initial administration of vancomycin 10 .…”

Section: Discussionmentioning

confidence: 99%

“…Although LABD is usually idiopathic, it may be induced by drugs, malignancies, or infections. Many drugs, such as acetaminophen 2 , amiodarone 3 , furosemide 4 , and phenytoin, 5 have been implicated as the cause; however, vancomycin has been found to be the one most commonly associated 6 . To our knowledge, there have been two cases of vancomycin-induced LABD reported in Korea to date.…”

Section: Introductionmentioning

confidence: 99%

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Vancomycin-induced Linear IgA Bullous Dermatosis: A Case Report and Review of the Literature

2008

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Linear IgA bullous dermatosis (LABD) is a rare autoimmune bullous disease that can either occur without any apparent cause or be induced by the administration of certain drugs, the most common of which is vancomycin. We present a case of a 45-year-old woman who was diagnosed with vancomycin-induced LABD by the presence of a characteristic linear band of IgA along the basement membrane zone on direct immunofluorescence microscopy. Our patient showed complete recovery after a 2-week period during which vancomycin administration was discontinued. (Ann Dermatol (Seoul) 20(2) 102∼106, 2008)

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Vancomycin-induced Linear IgA Bullous Dermatosis: A Case Report and Review of the Literature

2008

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“…On the other side, reports have shown that as many as two-thirds of all occurrences may be druginduced. The most frequently implicated drugs were antibiotics, especially vancomycin, penicillin, amoxicillin-clavulanate, cephalosporin, sulfonamides, sulfamethoxazole/trimethoprim, non-steroidal antiinflammatory drugs such as diclofenac, naproxen, piroxicam, antihypertensive drugs such as captopril, angiotensin converting enzyme inhibitor (ACE), and diuretics (10).…”

Section: Discussionmentioning

confidence: 99%

Chronic bullous disease of childhood – A case report / Hronična bulozna bolest Kod Dece – Prikaz Slučaja

Gocev¹,

Damevska²,

Nikolovska³

et al. 2010

Serbian Journal of Dermatology and Venerology

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Linear IgA bullous dermatosis is a chronic, acquired, autoimmune subepidermal vesiculobullous disease. Both children and adults are affected. It is characterized by direct immunofluorescence findings of linear immunoglobulins class A (IgA) deposits along the dermal-epidermal junction (basement membrane zone). In children, the disease is commonly referred to as chronic bullous disease of childhood and it mostly affects children between 2 and 5 years. The onset of the disease is acute; the first episode is the most severe, while recurrences tend to wax and wane in severity and last till puberty or even longer. Diaminodiphenylsulfone is the treatment of choice, although systemic corticosteroids are reported to be very effective as well. We report a 3-year-old boy with a vesiculobullous eruption which developed one week following administration of cephalexin for upper respiratory infection. He was referred to our Clinic from other health institutions as treatment failure for suspected strophulus or impetigo bullosus. On admission, the patient had fever and numerous vesiculobullous and erosive lesions distributed on the face and trunk. After immunohistological verification, the treatment with prednisone 25 mg/d was introduced, due to rapid progression of the disease and the fact that diaminodiphenylsulfone was not available. Improvement occurred after 2 weeks, so the dose was carefully tapered, taking into account the possibility of adrenal suppression. The medication was completely excluded within the next three months. No serious side effects were observed, except transitory hirsutism. The patient has had no relapses over the last 20 months of clinical follow-up.

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“…There are several reports describing association of LABD with various drugs. 4 The most common offending drug has been vancomycin. 4,5 Drug-induced LABD has some differences when compared to the idiopathic variant.…”

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confidence: 99%

“…4 The most common offending drug has been vancomycin. 4,5 Drug-induced LABD has some differences when compared to the idiopathic variant. The drug-induced type tends to show the transient nature of the cutaneous symptoms, lack of mucosal or conjunctival lesions, and rapid improvement after discontinuation of the medication, and lack of circulating IgA antibodies.…”

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confidence: 99%

Linear immunoglobulin A bullous dermatosis possibly induced by mefenamic acid

Jin

Nakano

Akasaka

et al. 2010

The Journal of Dermatology

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Dear Editor, Linear immunoglobulin A bullous dermatosis (LABD) is a relatively rare autoimmune blistering disease characterized clinically by the presence of small tense blisters and immunologically by the presence of immunoglobulin (Ig)A at the dermal-epidermal junction.1 Idiopathic, systemic disease-related and drugrelated types of this disorder have been described so far. 1,2 We report the first case of LABD possibly associated with mefenamic acid, which is well known to induce commonly fixed drug eruptions.A 69-year-old Japanese woman presented with multiple blisters and erosions on her trunk, hip and thighs. She first noticed the skin eruption after taking mefenamic acid for 7 days for treatment of a common cold and the skin lesions were only a few blisters at the beginning. She visited a dermatology practitioner and a diagnosis of fixed drug eruption by mefenamic acids was made. Thus, she was given an oral antihistaminic drug and topical corticosteroid ointment. However, the eruption exacerbated and she was then referred to our clinic. Physical examination revealed some tense bullae and edematous erythema with vesiculobullae and erosions arranged annularly on her trunk, hip, thighs and upper extremities (Fig 1a,b). Mucosal lesions were not found in mucous membranes and there were no scars and milia. History taking revealed that the patient had experienced a similar eruption after taking mefenamic acids approximately 7 years before visiting us. Histological examination showed a subepidermal blister with a dense inflammatory infiltrate of lymphocytes, neutrophils and eosinophils in the edematous superficial dermis. Acantholysis and papillary abscess were not seen. All the laboratory data obtained were within normal limits.Direct immunofluorescent study revealed linear deposits of IgA and IgG at the basement membrane zone (BMZ) (Fig 1c,d). Indirect immunofluorescence found anti-BMZ antibodies: IgA (titer 1:160) and IgG (titer 1:160). Also, indirect immunofluorescence on 1 mol⁄ L NaCl-split human skin sections demonstrated that both IgA and IgG antibodies reacted with the epidermal side of the split (data not shown). Immunoblot analysis with human epidermal extracts failed to detect a clear band (data not shown). Enzyme-linked immunosorbent assays (ELISA) for both BP180 and BP230 were negative.We made a diagnosis of LABD based on clinical observations and immunological results. Also, we suspected mefenamic acid as a causative drug. We started treatment of 25 mg ⁄ day prednisone and the patient showed good response when we tapered prednisone.Linear IgA bullous dermatosis is an acquired immune-mediated subepidermal blistering disease characterized by circulating IgA autoantibodies, and now the soluble 120-kDa (LAD-1) ⁄ 97-kDa (LABD97) ectodomain of BP180 is the major target of the IgA antibodies. This condition is currently classified as a pemphigoid disease, which also includes bullous pemphigoid, pemphigoid gestationis and mucous membrane pemphigoid.3 It is well known that LABD sometimes shows an antigenic het...

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Drug-Induced Linear IgA Bullous Dermatosis

Cited by 51 publications

References 51 publications

Vancomycin-induced Linear IgA Bullous Dermatosis: A Case Report and Review of the Literature

Vancomycin-induced Linear IgA Bullous Dermatosis: A Case Report and Review of the Literature

Chronic bullous disease of childhood – A case report / Hronična bulozna bolest Kod Dece – Prikaz Slučaja

Linear immunoglobulin A bullous dermatosis possibly induced by mefenamic acid

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