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Correspondence |

Paraneoplastic Pemphigus With Anti–Laminin-332 Autoantibodies in a Patient With Follicular Dendritic Cell Sarcoma

Kazumitsu Sugiura, MD, PhD; Hiroshi Koga, MD, PhD; Riho Ishikawa, MD; Takaaki Matsumoto, MD; Mika Matsubara, MD; Rika Hagiwara, MD; Yoshinao Muro, MD, PhD; Takashi Hashimoto, MD, PhD; Masashi Akiyama, MD, PhD
JAMA Dermatol. 2013;149(1):111-113. doi:10.1001/2013.jamadermatol.512.
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To our knowledge, only 4 cases of paraneoplastic pemphigus (PNP) associated with follicular dendritic cell sarcoma (FDCS) have been reported.14 We describe herein a patient with PNP associated with FDCS with anti–laminin-332 autoantibodies.

Correspondence: Dr Sugiura, Department of Dermatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Japan, 466-8550 (kazusugi@med.nagoya-u.ac.jp).

Conflict of Interest Disclosures: None reported.

Funding/Support: This study was supported in part by Grants-in-Aid for Scientific Research (C) 23591617 (Dr Sugiura) and (A) 23249058 (Dr Akiyama) from the Ministry of Education, Culture, Sports, Science and Technology of Japan.

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Figure 1. Clinical and histopathological features of the patient. A, Erosions are observed on the whole body. B, Papillomatous hyperplasia on the tongue remains even after skin manifestations have improved owing to tumor resection and postoperative chemotherapy. C, Histopathologic evidence of erosion on the trunk (hematoxylin-eosin, original magnification ×400). D, Indirect immunofluorescence (IF) of normal human skin by circulating IgG of the patient at a titer of 1:160 (original magnification ×400). E, Indirect IF of 1M sodium chloride–split normal human skin by circulating IgG of the patient at a titer of 1:40 (original magnification ×200).

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Figure 2. Immunoblot analyses of circulating autoantibodies in the patient's serum performed as described previously.1,5 A, Results of immunoblot analysis using epidermal extract: control paraneoplastic pemphigus (PNP) serum (lane 1) recognized the 210-kDa envoplakin and the 190-kDa periplakin, which were also detected by IgG (lane 2) and IgA (lane 3) antibodies in the serum of the present patient; control pemphigus vulgaris (PV) serum (lane 4) reacted with the 160-kDa desmoglein 1 and the 130-kDa desmoglein 3; control bullous pemphigoid (BP) serum (lane 5) reacted with the 180-kDa BP180. B, Results of immunoblot analysis using purified human laminin-332 before (lanes 2 and 3) and after (lanes 6 and 7) COP therapy was started (cyclophosphamide, vincristine [Oncovin; Genus Pharmaceuticals], and predonisone). A control antilaminin-332 mucous membrane (MMP) serum (lanes 1 and 5) reacted with the 165-kDa and 145-kDa α3 subunits, the 140-kDa β3 subunit, and the 105-kDa γ2 subunit. IgG antibodies in the serum of the present case (lanes 2 and 6) reacted with the 140-kDa β3 subunit and the 105-kDa γ2 subunit. No specific band was observed for IgA antibodies in the serum of the present patient (lanes 3 and 7) nor for IgG antibodies in serum from a healthy control (lanes 4 and 8).

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