Indirect immunofluorescence on rat bladder transitional epithelium: A test with high specificity for paraneoplastic pemphigus

Liu, Aries Y.; Valenzuela, Rafael; Helm, Thomas N.; Camisa, Charles; Melton, Alton L.; Bergfeld, Wilma F.

doi:10.1016/0190-9622(93)70095-b

Cited by 109 publications

(54 citation statements)

References 7 publications

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“…3,14,17 However, Cozzani et al 7 found 21% positive IIF-RBE in patients with PV, which is in accord with our data (22% in PV patients). These authors suggested a role for anti-DP in determining disease severity.…”

Section: Discussionsupporting

confidence: 92%

Analysis of the reactivity of indirect immunofluorescence in patients with pemphigus foliaceus and pemphigus vulgaris using rat bladder epithelium as a substrate

2011

Journal of the American Academy of Dermatology

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OBJECTIVES:To evaluate the reactivity of indirect immunofluorescence using rat bladder epithelium as a substrate in patients with pemphigus foliaceus and pemphigus vulgaris from the Department of Dermatology, University of Sã o Paulo Medical School, Brazil. METHODS:Thirty-two patients (8 male and 24 female) from the Department of Dermatology, University of Sã o Paulo Medical School, were selected. Three had mucosal pemphigus vulgaris, 20 had mucocutaneous pemphigus vulgaris, and 9 had pemphigus foliaceus. Patients' sera were tested by indirect immunofluorescence performed on human foreskin and rat bladder epithelium and by ELISA assays utilizing baculovirus-expressed recombinant desmoglein 3 and desmoglein 1. RESULTS:No patients with mucosal pemphigus vulgaris, 5 of 20 patients with mucocutaneous pemphigus vulgaris (25%) and 4 of 9 patients with pemphigus foliaceus (44%) had positive indirect immunofluorescence using rat bladder epithelium as a substrate.CONCLUSION: Indirect immunofluorescence using rat bladder epithelium as a substrate is recommended whenever a diagnosis of paraneoplastic pemphigus is considered. The identification of a subset of pemphigus foliaceus and pemphigus vulgaris patients that recognizes desmoplakins by this laboratory tool is critical to avoid the misdiagnosis of paraneoplastic pemphigus.KEYWORDS: Pemphigus vulgaris; Paraneoplastic pemphigus; Indirect immunofluorescence; Rat bladder epithelium; Pemphigus foliaceus.Ortolan DG, Souza DPG, Aoki V, Santi CG, Gabbi TVB, Ichimura LMF, et al. Analysis of the reactivity of indirect immunofluorescence in patients with pemphigus foliaceus and pemphigus vulgaris using rat bladder epithelium as a substrate.

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Section: Discussionsupporting

confidence: 92%

Analysis of the reactivity of indirect immunofluorescence in patients with pemphigus foliaceus and pemphigus vulgaris using rat bladder epithelium as a substrate

2011

Journal of the American Academy of Dermatology

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“…The latter are already numerous, and the list seems destined to increase along with additional reports on this topic. It includes: (a) drugs, in particular the thiol drugs that held a preponderant place (81% of the total) [1][2][3][4][5], (b) physical agents such as burns [6] or UV radiation [7,8], (c) infec tions, in particular viral ones [9,10], (d) neoplasms [11,12], (e) hormones and pregnancy 113, 14], (f) contact der matitis [15] and (g) emotional stress 116, 17], Although the medical literature is replete with references of numerous factors that can induce or trigger pemphigus, diet factors are only rarely mentioned as capable of inducing the dis ease. In this regard, an anecdotal episode of pemphigus relapse after eating fish has been reported [1],…”

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confidence: 99%

Possible Nutritional Factors in Induced Pemphigus

Brenner¹,

Wolf²

1994

Dermatology

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Today it is generally accepted that every drug that possesses an active thiol group in its molecule is capable of inducing pemphigus. Some plants, in particular those belonging to the Allium group, contain several active compounds with stable disulfide and thiol groups in their molecule. The Allium group contains many important vegetables like onion, leek and garlic. Examples of molecules with an active thiol group are: CH₂ = CH –– CH₂ –– S –– S –– CH₂ –– CH = CH₂ (diallyl disulfide) or CH₂ = CH –– CH₂ –– S(O)S –– CH₂ –– CH = CH₂ (allicin). It is suggested that some foods, in particular vegetables of the Allium group that contain active thiol groups in their molecule, could contribute to the induction of pemphigus. In general, nutritional factors should be added to the list of exogenous factors that are capable of inducing pemphigus.

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“…However, indirect immunofluorescence may be negative in as many as one fourth of patients, and in this case, immunoprecipitation should be used to aid in the diagnosis. 13 There have been a number of hypotheses regarding the pathogenesis of PNP. Xuejun and Bingxin 14 isolated B-lymphocyte clones from a Castleman's tumor, which specifically reacted to epidermal proteins, indicating that the associated tumors may produce auto-antibodies.…”

Section: Discussionmentioning

confidence: 99%

Paraneoplastic Pemphigus in a Patient with Carcinosarcoma of the Uterus

Giebel¹,

Shah²

2010

TMF

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The patient is a 68-year-old female with hypertension, chronic obstructive pulmonary disease, without medical follow-up for several years, who initially presented with skin blisters and oral lesions, which were biopsied by her dermatologist and found to be bullous pemphigoid. She was treated with a course of oral prednisone and had resolution of her skin and oral lesions. Three months later, she presented with a swollen leg and was diagnosed with a deep venous thrombosis, for which she was started on coumadin and had an inferior vena cava filter placed. She then had hemoptysis a few days later, after which the coumadin was held. A chest computed tomography (CT) done at that time found a right middle lobe consolidation consistent with aspiration pneumonia and a cavitary lesion in the left upper lobe of her lung, which was biopsied and found to be a necrotizing cavitary lung lesion. After being ruled out for tuberculosis, she had an outpatient positron emission tomography (PET) scan which was positive for a 2.7cm left lower lobe cavitary lesion and a 9 cm pelvic mass with hypermetabolic activity, as well as small liver lesions. Concurrently, she complained of dysphagia and 30-lbs of weight loss over the prior six months, so the decision was made to undergo an outpatient esophagogastroduodenoscopy (EGD). The EGD could not be completed secondary to a stricture in the distal esophagus; however, pemphigus ulcers were seen in the mouth and esophagus. Given the patient's degree of malnourishment and dehydration, she was admitted to the outside hospital. On admission, she was found to have leukocytosis with a white blood cell count of 37,000/L, hypercalcemia with a calcium of 13mg/dL, hypotension, and acute renal failure with a creatinine of 4.4mg/dL. Her parathyroid hormone-related protein (PTHrP) was 105 pmol/L (normal <1.3 pmol/L), while her intact parathyroid hormone (PTH) was <3pg/mL (10-55 pg/ml). A serum protein electrophoresis with immunoelectrophoreis was positive for an IgG lambda paraprotein. On bone marrow biopsy, there were 25% plasma cells consistent with multiple myeloma, though this diagnosis was questioned after transfer. For treatment of her hypercalcemia, she was given intravenous fluids and calcitonin with minimal improvement, but with resolution of her renal failure.The esophageal biopsy showed squamous mucosa with necrotic ulcer and chronic inflammation with fibrinous exudate. The pelvic mass was also biopsied which was consistent with carcinosarcoma with massive necrosis. The pathology revealed myxoid high-grade spindle cell sarcoma with pleomorphosis and extensive mitosis and poorly differentiated adenocarcinoma with papillary serous differentiation, as well as some smooth muscle differentiation. During her hospitalization, the skin blisters reappeared and were biopsied. The biopsy was consistent with paraneoplastic pemphigus. She was treated with three days of intravenous immunoglobulin (IVIg). She had an open jejunostomy tube placed for nutrition. At this point, she was transferred to Thomas Jef...

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Indirect immunofluorescence on rat bladder transitional epithelium: A test with high specificity for paraneoplastic pemphigus

Cited by 109 publications

References 7 publications

Analysis of the reactivity of indirect immunofluorescence in patients with pemphigus foliaceus and pemphigus vulgaris using rat bladder epithelium as a substrate

Analysis of the reactivity of indirect immunofluorescence in patients with pemphigus foliaceus and pemphigus vulgaris using rat bladder epithelium as a substrate

Possible Nutritional Factors in Induced Pemphigus

Paraneoplastic Pemphigus in a Patient with Carcinosarcoma of the Uterus

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