Atypical bullous pemphigoid after linagliptin intake (Preprint)

2020 ◽  
Author(s):  
Antoine Salloum ◽  
Nagham Bazzi ◽  
Maya Habre
Keyword(s):  
Skin Lesion ◽  
Basement Membrane ◽  
Upper Extremity ◽  
Bullous Pemphigoid ◽  
The Elderly ◽  
Direct Immunofluorescence ◽  
Erythematous Papule ◽  
Immunologic Reaction ◽  
Pruritic Skin

UNSTRUCTURED Bullous pemphigoid is among the commonest pruritic skin lesion and affecting mainly the elderly. It is caused by an immunologic reaction between auto-antibodies and hemidesmosome proteins. Several forms of typical bullous pemphigoid post linaglipltin have been reported. However, this is the first reported case of atypical non-bullous pemphigoid after linagliptin intake. The patient presented with multiple erythematous papule and nodules on the upper extremity and on trunk. Diagnosis was made with biopsy followed by direct immunofluorescence. Direct immunofluorescence showed linear IgG and C3 antibodies to hemidesmosomes at lamina Lucida of the basement membrane.

scholarly journals PUVA Induced Bullous Pemphigoid in a Patient with Mycosis Fungoides

2017 ◽  
Vol 2017 ◽  
pp. 1-3 ◽  
Author(s):  
Birgül Özkesici ◽  
Saliha Koç ◽  
Ayşe Akman-Karakaş ◽  
Ertan Yılmaz ◽  
İbrahim Cumhur Başsorgun ◽  
...  
Keyword(s):  
Basement Membrane ◽  
Mycosis Fungoides ◽  
Bullous Pemphigoid ◽  
Normal Skin ◽  
The Elderly ◽  
Physical Factor ◽  
Direct Immunofluorescence ◽  
Puva Therapy ◽  
Inducing Factors ◽  
Upper Abdomen

Background. Bullous pemphigoid is an autoimmune subepidermal blistering skin disease in which autoantibodies are directed against components of the basement membrane. The disease primarily affects the elderly people and in most of the patients inducing factors cannot be identified. Herein, we report a case of BP that occurred in a patient who was receiving PUVA therapy for the treatment of mycosis fungoides. Main Observation. A 26-year-old woman with mycosis fungoides developed blisters while receiving PUVA therapy. On physical examination tense bullae on the normal skin, remnants of blisters, and erosions were observed on her breasts, the chest wall, and the upper abdomen. Histopathological investigations revealed subepidermal blisters with eosinophilic infiltration and in direct immunofluorescence examination linear deposition of IgG along the basement membrane zone was observed. The diagnosis of bullous pemphigoid was also confirmed by ELISA and BIOCHIP mosaic-based indirect immunofluorescence test. Conclusions. PUVA therapy is an extremely rare physical factor capable of inducing bullous pemphigoid. So the development of blistering lesions during PUVA therapy may be suggestive sign of a bullous disease such as bullous pemphigoid and it should be excluded with proper clinical and laboratory approaches immediately after withdrawal of PUVA therapy.

Bullous Scabies Simulating Pemphigoid

2011 ◽  
Vol 15 (1) ◽  
pp. 55-57 ◽  
Author(s):  
T. Roxana Stan ◽  
Stefano Piaserico ◽  
Matteo Bordignon ◽  
Roberto Salmaso ◽  
Edoardo Zattra ◽  
...  
Keyword(s):  
Skin Lesion ◽  
Bullous Pemphigoid ◽  
Steroid Treatment ◽  
Social Conditions ◽  
Direct Immunofluorescence ◽  
Benzyl Benzoate ◽  
Bullous Disease ◽  
Autoimmune Bullous Disease ◽  
Skin Specimen ◽  
Desmoglein 3

Background: Scabies is a contagious infestation affecting subjects of all ages, races, and social conditions. Objective: We report a case of a 79-year-old man who developed a bullous pemphigoid-like eruption. He presented to our unit 4 months after the onset of symptoms. An autoimmune bullous disease was suspected. Direct immunofluorescence on a skin specimen and anti-desmoglein 1, anti-desmoglein 3, and anti-bullous pemphigoid antigen 180 were negative. Surprisingly, the histology of a skin lesion demonstrated the presence of scabies, which was successfully treated with benzyl benzoate 20%. Conclusion: The diagnosis of bullous scabies should be considered for any bullous eruptions accompanied by papules and itching resistant to steroid treatment and with negative immunopathologic findings.

Distinguishing Epidermolysis Bullosa Acquisita From Bullous Pemphigoid Without Direct Immunofluorescence

2017 ◽  
Vol 22 (1) ◽  
pp. 22-24 ◽  
Author(s):  
Kerry M. Gardner ◽  
Richard I. Crawford
Keyword(s):  
Basement Membrane ◽  
Bullous Pemphigoid ◽  
Epidermolysis Bullosa ◽  
Periodic Acid ◽  
Epidermolysis Bullosa Acquisita ◽  
Direct Immunofluorescence ◽  
Periodic Acid Schiff ◽  
Eosinophilic Infiltrate ◽  
Neutrophilic Infiltrate ◽  
Subepidermal Blister

Background: It has been postulated that periodic acid–Schiff staining of basement membrane can predict direct immunofluorescence patterns seen in epidermolysis bullosa acquisita and bullous pemphigoid. It has also been suggested that the type of inflammatory infiltrate or presence of fraying of basal keratinocytes may differentiate these two conditions. Objective: In this study, we aimed to confirm these observations. Methods: We reviewed 13 cases of direct immunofluorescence-confirmed epidermolysis bullosa acquisita and 19 cases of direct immunofluorescence-confirmed bullous pemphigoid, all with a subepidermal blister in the routinely processed specimen. The gold standard for diagnosis of epidermolysis bullosa acquisita vs bullous pemphigoid was taken to be identification of immune deposits on the dermal side (‘floor’ for epidermolysis bullosa acquisita) or the epidermal side (‘roof’ for bullous pemphigoid) of the salt-split direct immunofluorescence specimen. Our tests to distinguish epidermolysis bullosa acquisita from bullous pemphigoid on the routinely processed biopsy included periodic acid–Schiff basement membrane on the blister roof, neutrophilic infiltrate, lack of eosinophilic infiltrate, and absence of keratinocyte fraying. Results: Sensitivity and specificity for each test were as follows: periodic acid–Schiff staining of roof (sensitivity 25%, specificity 95%), neutrophilic infiltrate (sensitivity 54%, specificity 74%), lack of eosinophilic infiltrate (sensitivity 92%, specificity 68%), and absence of keratinocyte fraying (sensitivity 62%, specificity 58%). Conclusions: Features in the routinely processed biopsy were unable to reliably distinguish between epidermolysis bullosa acquisita and bullous pemphigoid. Direct immunofluorescence on salt-split skin remains the standard for differentiation.

Effect of Loratadine for Chronic Pruritic Skin Disease of the Elderly

2008 ◽  
Vol 70 (3) ◽  
pp. 308-312 ◽  
Author(s):  
Ryota TOKUMARU ◽  
Shinichi IMAFUKU ◽  
Juichiro NAKAYAMA
Keyword(s):  
Skin Disease ◽  
The Elderly ◽  
Pruritic Skin

scholarly journals Adult Female With Upper Extremity Skin Lesion

2021 ◽  
Vol 77 (5) ◽  
pp. 548-560
Author(s):  
Gifford Mezey ◽  
Jacob D. Isserman ◽  
Jonathan E. Davis
Keyword(s):  
Skin Lesion ◽  
Upper Extremity ◽  
Adult Female

scholarly journals Diffuse Bullous Eruptions in an Elderly Woman: Late-Onset Bullous Systemic Lupus Erythematosus

2016 ◽  
Vol 8 (3) ◽  
pp. 278-282 ◽  
Author(s):  
Prajwal Boddu ◽  
Mojtaba Nadiri ◽  
Owais Malik
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Late Onset ◽  
Clinical History ◽  
The Elderly ◽  
Direct Immunofluorescence ◽  
Systemic Lupus ◽  
Diverse Range ◽  
American College Of Rheumatology ◽  
Type Vii Collagen

Vesiculobullous eruptions in the elderly represent a diverse range of varying pathophysiologies and can present a significant clinical dilemma to the diagnostician. Diagnosis requires a careful review of clinical history, attention to detail on physical and histomorphological examination, and appropriate immunofluorescence testing. We describe the case of a 73-year-old female who presented to our hospital with a painful blistering skin rash developed over 2 days. Examination of the skin was remarkable for numerous flaccid hemorrhagic bullae on a normal-appearing nonerythematous skin involving both the upper and lower extremities. Histopathology of the biopsy lesion showed interface change at the epidermo-dermal region with subepidermal blister formation, mild dermal fibrosis, and sparse interstitial neutrophilic infiltrate. Immunohistological analysis was significant for positive IgG basement membrane zone antibodies with a dermal pattern of localization on direct immunofluorescence and positive IgG antinuclear antibodies on indirect immunofluorescence. Evidence of antibodies to type VII collagen suggested the diagnosis of epidermolysis bullosa acquisita versus bullous systemic lupus erythematosus (BSLE). A diagnosis of BSLE was made based on positive American College of Rheumatology criteria, acquired vesiculo-bullous eruptions with compatible histopathological and immunofluorescence findings. This case illustrates one of many difficulties a physician encounters while arriving at a diagnosis from a myriad of immunobullous dermatoses. Also, it is important for internists and dermatologists alike to be aware of and differentiate this uncommon and nonspecific cutaneous SLE manifestation from a myriad of disorders presenting with vesiculobullous skin eruptions in the elderly.

scholarly journals Characterization of the skin microbiota in bullous pemphigoid patients and controls reveals novel microbial indicators of disease

2021 ◽  
Author(s):  
Meriem Belheouane ◽  
Britt M Hermes ◽  
Nina Van Beek ◽  
Sandrine Benoit ◽  
Philippe Bernard ◽  
...  
Keyword(s):  
Bullous Pemphigoid ◽  
Disease Risk ◽  
Disease Status ◽  
The Elderly ◽  
Future Research ◽  
Sampling Effort ◽  
Skin Microbiota ◽  
Important Indicator ◽  
Blistering Disease ◽  
Microbe Interactions

Bullous pemphigoid (BP) is an autoimmune skin blistering disease afflicting mostly the elderly and is associated with significantly increased mortality. Here, we conducted the most extensive sampling effort of skin microbiota in BP to date to analyze whether intra-individual, body-site-specific, and/or geographical variation contributes to the emergence of BP. We find marked differences in the skin microbiota of BP patients compared to that of control subjects, and moreover that disease status rather than skin biogeography governs the skin microbiota composition in BP. Our data reveal a discernible transitional stage between normal and diseased skin in BP characterized by a loss of protective microbiota and an increase in sequences matching Staphylococcus aureus, a known inflammation-promoting species. Notably, S. aureus is ubiquitously associated with disease status, suggesting that this taxon is an important indicator of BP. Importantly, differences in a few key indicator taxa are able to reliably discriminate between BP patients and controls, characterized by their opposing abundance patterns. This may serve as valuable information for assessing disease risk and treatment outcomes. Future research will focus on the functional analysis of host-microbe and microbe-microbe interactions and the relevance of the host genome for microbiota abundances to identify novel BP treatment approaches.

scholarly journals Postinfectious Glomerulonephritis with Crescents in an Elderly Diabetic Patient after Acute Gastroenteritis: Case Report

2019 ◽  
Vol 9 (2) ◽  
pp. 64-71
Author(s):  
Satyanand Sathi ◽  
Anil Kumar Garg ◽  
Ajay Kumar Singh ◽  
Manoj Kumar Singh ◽  
Virendra Singh Saini
Keyword(s):  
Acute Gastroenteritis ◽  
Correct Diagnosis ◽  
Kidney Injury ◽  
The Elderly ◽  
Normal Serum ◽  
Capillary Wall ◽  
Direct Immunofluorescence ◽  
Upper Respiratory Tract ◽  
Postinfectious Glomerulonephritis ◽  
Diffuse Proliferative Glomerulonephritis

Postinfectious glomerulonephritis (PIGN) is primarily a disease of childhood. It occurs after upper respiratory tract infection or skin infections. Streptococcus is the most common causative agent, but in the elderly, staphylococcus is the main culprit. In adults, PIGN is more common in immunocompromised patients, particularly diabetics and alcoholics. Here, we report the case of an elderly diabetic male who presented with severe acute kidney injury with active urinary sediment after acute gastroenteritis. Additional analyses revealed a very low serum C3 level and a normal serum C4 level. Renal biopsy showed diffuse proliferative glomerulonephritis with crescents. Direct immunofluorescence showed mesangial and capillary wall staining for C3 and IgG (2+, mesangial and segmental capillary wall, granular). Renal electron microscopy showed subepithelial hump-like electron-dense deposits. The role of steroid in the treatment of PIGN is controversial and there is no standard protocol, but our patient responded very well to steroid as he did not require hemodialysis after 2 weeks of initiation of steroid therapy. We should be aware of an atypical presentation of PIGN in elderly to ensure correct diagnosis.

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