Development of pemphigus foliaceus in a mucous membrane pemphigoid patient: An insight into possible mechanism eliciting a distinct autoimmune bullous disease in a rare anti-basement membrane autoimmunity.

Mucous membrane pemphigoid (MMP) rarely coexists with another autoimmune bullous disease (AIBD). Herein, we report an extremely rare MMP case who sequentially developed pemphigus foliaceus (PF). A 72-year-old man had been treated by azathioprine monotherapy for anti-BP180 MMP for 1.5 years. Clinical findings suggestive of PF, represented by scaly erythema and erosions, started to appear approximately 1 month after the episode of diarrhea. Serological and immunohistochemical examinations confirmed the diagnosis of PF. The mucocutaneous lesions were controlled by oral azathioprine and topical corticosteroids. To our knowledge, this is a previously unreported case of PF coexistent with MMP. A literature review of MMP cases associated with AIBD elucidated that 16 out of 18 cases simultaneously developed MMP and AIBD, while only two cases were diagnosed sequentially by the changes in clinical symptoms similar to our case. The titer of anti-desmoglein 1 antibodies lineally correlated with the changes in the severity of scaly erythema. Mild but noticeable exacerbation of mucosal erosion prior to the gradual increase in anti-BP180-NC16a antibodies was also noted. Unlike in other cases where MMP/AIBD coexisted, sequential development of autoantibodies in our case cannot be explained by the epitope-spreading theory as autoantigens are micro-anatomically isolated from one other. The preceding viral infection and/or continuous moderate inflammation due to azathioprine monotherapy for MMP might have contributed to the development of PF in our case.

Relationship between relative lens position and appositional closure in eyes with narrow angles.

PURPOSE: To investigate the relationship between relative lens position (RLP) and appositional closure in eyes with narrow angles. METHODS: Ultrasound biomicroscopy (UBM) was used to measure anterior chamber depth (ACD) and lens thickness (LT), and the IOLMaster to measure axial length (AL). The number of quadrants with appositional closure was assessed by UBM under dark conditions. The RLP was calculated thus: RLP = 10 × (ACD + 0.5 LT) /AL. RESULTS: This study comprised 30 consecutive patients (30 eyes) with narrow-angle eyes defined as Shaffer grade 2 or lower and without peripheral anterior synechiae (24 women, 6 men; mean age ± SD, 67.3 ± 10.4 years; range, 42-87 years). Under dark conditions, 66.7% of the eyes with narrow angles showed appositional closure in at least one quadrant. Of the various ocular biometric parameters, only the RLP significantly decreased with appositional closure in at least one quadrant (P = 0.005). CONCLUSION: A decrease in the RLP can be predictive of appositional closure for narrow-angle eyes under dark conditions.

Effect of a single drop of latanoprost on intraocular pressure and blood-aqueous barrier permeability in patients with uveitis.

The purpose of our study is to evaluate the effect of a single drop of latanoprost on the intraocular pressure and blood-aqueous barrier permeability in 8 patients with uveitis. The degree of inflammation was determined by the intensity of aqueous flare measured with a laser flare cell meter every 2 hours from 11:00 to 17:00 hours for 2 days. Intraocular pressure was measured at 11:00 and 17:00 hours with a Goldmann applanation tonometer on both days. Patients were given one drop of 0.005% latanoprost at 11:00 hours on day 2 and results were compared with day 1 when latanoprost was not administered. There was no significant difference in the intensity of aqueous flare or intraocular pressure between day 1 and day 2. A single drop of latanoprost had little effect on intraocular pressure and aqueous flare intensity in patients with uveitis.