title: A subepidermal blistering disease with histopathological features of dermatitis herpetiformis and immunofluorescence characteristics of bullous pemphigoid: a novel subepidermal blistering disease or a variant of bullous pemphigoid?
abstract: A 64-year-old man presented with a bullous eruption which clinically and histopathologically resembled dermatitis herpetiformis. However, direct immunofluorescence analysis showed IgG deposits at the basement membrane zone, indicating a relationship with bullous pemphigoid or epidermolysis bullosa acquisita. Indirect immunofluorescence studies on salt-split skin showed binding of IgG mainly on the dermal side of the blister. Immunoblot analysis revealed a novel 200 kDa dermal antigen that could be associated with a major pathogen in this blistering disease. The histopathological similarity to dermatitis herpetiformis and the immunofluorescence findings indicating bullous pemphigoid or epidermolysis bullosa acquisita seem typical of a distinct subepidermal blistering disease characterized by this 200 kDa antigen. However, the pathogenetic role of autoantibodies against this antigen should be further elucidated before confirming whether this case represents a novel subepidermal blistering disease or a special variant of bullous pemphigoid.
authors.affiliation: Department of Dermatology, University of Graz, Austria.
authors.forename: W
authors.initials: W
authors.lastname: Salmhofer
authors.forename: Y
authors.initials: Y
authors.lastname: Kawahara
authors.forename: H P
authors.initials: HP
authors.lastname: Soyer
authors.forename: H
authors.initials: H
authors.lastname: Kerl
authors.forename: T
authors.initials: T
authors.lastname: Nishikawa
authors.forename: T
authors.initials: T
authors.lastname: Hashimoto
mesh_terms: D001324:Autoantigens / Q000032:analysis; D001485:Basement Membrane / Q000276:immunology; D003874:Dermatitis Herpetiformis / Q000473:pathology*; D003937:Diagnosis, Differential; D005455:Fluorescent Antibody Technique; D006801:Humans; D007074:Immunoglobulin G / Q000032:analysis; D008297:Male; D008875:Middle Aged; D010391:Pemphigoid, Bullous / Q000145:classification / Q000276:immunology; D012872:Skin Diseases, Vesiculobullous / Q000276:immunology / Q000473:pathology*
chemical_list: D001324:Autoantigens; D007074:Immunoglobulin G