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Correspondence |

Clinical Evidence of an Intermolecular Epitope Spreading in a Patient With Pemphigus Foliaceus Converting Into Bullous Pemphigoid

Jennifer D. Peterson, MD; Agnes J. Chang, MD; Lawrence S. Chan, MD
Arch Dermatol. 2007;143(2):264-276. doi:10.1001/archderm.143.2.272.
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Pemphigus foliaceus and bullous pemphigoid are 2 distinct forms of autoimmune blistering disorders with unique clinical, histologic, and immunologic features. We describe a patient with pemphigus foliaceus that converted into bullous pemphigoid, providing evidence of clinical intermolecular epitope spreading.

Sami  NAhmed  AR Dual diagnosis of pemphigus and pemphigoid: retrospective review of thirty cases in the literature. Dermatology 2001;202293- 301
PubMed Link to Article[[XSLOpenURL/10.1159/000051661]]
Harrington  CISneddon  IB Coexistence of bullous pemphigoid and pemphigus foliaceus. Br J Dermatol 1979;100441- 445
PubMed Link to Article[[XSLOpenURL/10.1111/bjd.1979.100.issue-4]]
Korman  NJStanley  JRWoodley  DT  et al.  Coexistence of pemphigus foliaceus and bullous pemphigoid. Arch Dermatol 1991;127387- 390
PubMed Link to Article[[XSLOpenURL/10.1001/archderm.1991.01680030107015]]
Chan  LSVanderlugt  CJHashimoto  T  et al.  Epitope spreading: lessons from autoimmune skin disease. J Invest Dermatol 1998;110103- 109
PubMed Link to Article[[XSLOpenURL/10.1046/j.1523-1747.1998.00107.x]]
Fairly  JAWoodley  DTChen  M  et al.  A patient with bullous pemphigoid and epidermolysis bullosa acquisita: an example of intermolecular epitope spreading. J Am Acad Dermatol 2004;51118- 122
PubMed Link to Article[[XSLOpenURL/10.1016/j.jaad.2003.12.033]]
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Contrasting features of 2001 and 2006 patient presentations. In 2001, the clinical findings were superficial erosions without intact blisters; histopathologically, an intraepidermal acantholytic blister; and under direct immunofluorescence, IgG deposits at epithelial cell surfaces. In 2006, the clinical findings were tense blisters and erosions; histopathologically, subepidermal blister with infiltrating eosinophils; under direct immunofluorescence, linear deposits of IgG at the skin basement membrane zone; and under indirect immunofluorescence, binding of IgG antibodies to the epidermal side of 1.0M sodium chloride–split skin (LL indicates the lamina lucida space). Original magnification ×40 for all histopathologic photographs. Photographs not available for the clinical presentation and direct immunofluorescence in 2001; indirect immunofluorescence and enzyme-linked immunosorbent assay (ELISA) were not done in 2001.

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