Subject(s)
Humans , Female , Adult , Biological Therapy/adverse effects , Pemphigus/chemically induced , Drug Eruptions/etiology , Antibodies, Monoclonal/adverse effects , Arthritis, Rheumatoid/drug therapy , Skin/pathology , Immunohistochemistry , Pemphigus/pathology , Drug Eruptions/pathology , Erythema/chemically induced , Erythema/pathology , Antibodies, Monoclonal, HumanizedABSTRACT
AbstractWe describe a 39-year-old woman with an apparent captopril-induced, contact mucosal-dominant pemphigus vulgaris and angioedema, who took captopril during a bout of arterial hypertension. This exposure suggests that captopril and pathophysiology of angioedema stimulated the development of pemphigus vulgaris, which was diagnosed using the novel, indirect immunofluorescence BIOCHIP mosaic, with the modification to detect serum IgG4 autoantibodies. We discuss the patient, who experienced a chain of events leading to the active stage of pemphigus vulgaris, and review concepts of pemphigus vulgaris inducible by drugs and pathological immunity.
Subject(s)
Adult , Female , Humans , Angioedema/chemically induced , Antihypertensive Agents/adverse effects , Captopril/adverse effects , Mouth Diseases/chemically induced , Pemphigus/chemically induced , Angioedema/pathology , Fluorescent Antibody Technique, Direct , Immunoglobulin G/blood , Mouth Diseases/pathology , Mouth Mucosa/drug effects , Mouth Mucosa/pathology , Pemphigus/pathologyABSTRACT
Pênfigo Vegetante foi primeiramente descrito como uma variante do pênfigo vulgar, em 1876, por Neumann. Em 1889, Hallopeau descreveu um paciente com pústulas e placas vegetantes, e sugeriu ser uma variante do Pênfigo Vegetante de Neumann. Ambos os tipos de pênfigo vegetante são caracterizados pelo desenvolvimento de placas vegetantes, especialmente, em dobras (axila, inguinal, perianal). Os autores apresentam e discutem um caso de Pênfigo Vegetante com uma clínica incomum, com ausência de acometimento de mucosas e áreas de flexão, em paciente idosa, associado ao uso de enalapril como possível desencadeador. Diagnóstico clínico e histológico sugestivos de Pênfigo Vegetante tipo Hallopeau.
Pemphigus Vegetans was first described as a variant of Pemphigus Vulgaris in 1876 by Neumann. In 1889, Hallopeau described a patient with pustules and vegetating plaques, suggesting that it would be a variant of Pemphigus Vegetans of Neumann. Both types of Pemphigus Vegetans are characterized by the development of vegetating plaques especially on skin folds (axillae, groin, perianal region). The authors present and discuss a case of Pemphigus Vegetans with an unusual clinical presentation lacking involvement of mucous membrane and flexor surfaces in an elderly female patient, associated with the use of enalapril as possible trigger factor. Clinical and histological diagnosis were suggestive of Pemphigus Vegetans of the Hallopeau type.
Subject(s)
Aged , Female , Humans , Antihypertensive Agents/adverse effects , Enalapril/adverse effects , Pemphigus/chemically induced , Anti-Inflammatory Agents/therapeutic use , Diagnosis, Differential , Pemphigus/pathology , Prednisone/therapeutic useABSTRACT
Bucillamine is a disease modifying anti-rheumatic drug, structurally similar to D-penicillamine. Although D-penicillamine-induced pemphigus has been not infrequently demonstrated, pemphigus associated with bucillamine was rarely reported. We describe a patient complicating pemphigus vulgaris after bucillamine treatment in rheumatoid arthritis (RA) and polymyositis (PM) overlap syndrome. PM and RA overlap syndrome was diagnosed three years ago and bucillamine was administrated for 20 months. Skin lesions including erythematous flaccid blisters on her chest, axillae, and back were occurred and were compatible with pemphigus vulgaris by typical pathology. Withdrawal from bucillamine and prednisolone treatment made rapid improvement of pemphigus lesions.