Histopathology of anti-laminin 5 mucous membrane pemphigoid

Rosé, Christian; Schmidt, Enno; Kerstan, Andreas; Thoma-Uszynski, Sybille; Wesselmann, Ulrich; Käsbohrer, Ulrich; Zillikens, Detlef; Shimanovich, Iakov

doi:10.1016/j.jaad.2009.02.012

Cited by 36 publications

(34 citation statements)

References 30 publications

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“…Anti-laminin-332 MMP is considered to be a severe refractory form of pemphigoid presenting often as a cicatricial form but also as a noncicatricial form of MMP. 25 The oral involvement was severe in our patient, but there was also marked cutaneous involvement and the lesions did not scar. Anti-laminin-332 MMP is associated with an increased risk for a malignant tumor.…”

Section: Discussionsupporting

confidence: 43%

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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Section: Discussionsupporting

confidence: 43%

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

et al. 2013

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“…There may be three possibilities for massive lymphocytic infiltrations that occurred in our cases; i.e., severe MMP conditions cause more intensive infiltration, more chronic conditions cause greater inflammation with extensive lymphocytic infiltration, and associated infection of microbes, including bacteria and viruses, causes mononuclear cell infiltration.…”

Section: Discussionmentioning

confidence: 96%

Four cases of mucous membrane pemphigoid with clinical features of oral lichen planus

et al. 2015

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“…Commonly, monocytes, histiocytes, plasma cells as well as eosinophils and neutrophils are seen in mucosal biopsies (Fig. 9b ) [126]. …”

Section: Mucous Membrane Pemphigoidmentioning

confidence: 99%

Molecular Diagnosis in Autoimmune Skin Blistering Conditions

Otten¹,

Hashimoto²,

Hertl³

et al. 2014

CMM

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Blister formation in skin and mucous membranes results from a loss of cell-cell or cell-matrix adhesion and is a common outcome of pathological events in a variety of conditions, including autoimmune and genetic diseases, viral and bacterial infections, or injury by physical and chemical factors. Autoantibodies against structural components maintaining cell-cell and cell-matrix adhesion induce tissue damage in autoimmune blistering diseases. Detection of these autoantibodies either tissue-bound or circulating in serum is essential to diagnose the autoimmune nature of disease. Various immunofluorescence methods as well as molecular immunoassays, including enzyme-linked immunosorbent assay and immunoblotting, belong to the modern diagnostic algorithms for these disorders. There is still a considerable need to increase awareness of the rare autoimmune blistering diseases, which often show a severe, chronic-relapsing course, among physicians and the public. This review article describes the immunopathological features of autoimmune bullous diseases and the molecular immunoassays currently available for their diagnosis and monitoring.

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Histopathology of anti-laminin 5 mucous membrane pemphigoid

Cited by 36 publications

References 30 publications

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

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

Four cases of mucous membrane pemphigoid with clinical features of oral lichen planus

Molecular Diagnosis in Autoimmune Skin Blistering Conditions

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