An erythrodermic variant of pemphigus foliaceus with puzzling histologic and immunopathologic features.

Abstract

BACKGROUND:

Pemphigus foliaceus is an autoimmune blistering disorder that affects the skin owing to autoantibodies against desmoglein 1.

METHODS:

We employed clinical, histologic, immunopathologic, and serum laboratory studies to investigate a case of an erythrodermic variant of pemphigus foliaceus in an elderly man following treatment with bisoprolol-hydrochlorothiazide.

RESULTS:

Early histopathology revealed psoriasiform dermatitis, but later biopsies showed subcorneal and granular layer separation with neutrophilic infiltrate. Direct immunofluorescence showed intercellular deposits of immunoglobulin G throughout the epidermis, granular staining of C3 along the basement membrane zone, and fibrin and C3 deposition around the blood vessels. Indirect immunofluorescence on monkey esophagus showed a titer of greater than 1:1,280. Indirect immunofluorescence on rat bladder, antinuclear antibody, lupus panel, and kidney function panel were all negative.

CONCLUSION:

There are no reports in the literature of pemphigus foliaceus being induced by bisoprolol, but reports exist of propanolol resulting in drug-induced pemphigus foliaceus.

• Authors: Jennifer D Peterson, Sophie M Worobec, Lawrence S Chan
• Journal: Journal of cutaneous medicine and surgery (J Cutan Med Surg) 2007 Sep-Oct Vol. 11 Issue 5 Pg. 179-84 ISSN: 1203-4754 [Print] United States
• PMID: 17942028 (Publication Type: Case Reports, Journal Article)

Chemical References

• Autoantibodies
• Complement C3
• Desmoglein 1
• Immunoglobulin G

Topics

• Aged
• Autoantibodies (analysis)
• Complement C3 (analysis)
• Dermatitis, Exfoliative (etiology)
• Desmoglein 1 (immunology)
• Humans
• Immunoglobulin G (analysis)
• Immunologic Tests
• Male
• Neutrophils
• Pemphigus (classification, complications, diagnosis, immunology)
• Skin (immunology, pathology)