title: A subepidermal bullous eruption associated with IgG autoantibodies to a 200 kd dermal antigen: the first case report from the United States.
abstract: We describe an 81-year-old white man in whom a subepidermal bullous eruption developed that clinically resembled bullous pemphigoid. The eruption promptly responded to oral tetracycline and niacinamide and topical clobetasol. Histologic examination of perilesional skin revealed neutrophilic infiltration with formation of papillary microabscesses and subepidermal cleavage. Direct immunofluorescence showed linear deposition of IgG and C3 along the basement membrane zone. By indirect immunofluorescence, circulating IgG autoantibodies bound exclusively to the dermal side of salt-split normal human skin. Immunoblot analysis demonstrated that the patient's autoantibodies reacted with a 200 kd dermal protein that was different from type VII collagen, the epidermolysis bullosa acquisita autoantigen. This patient represents the first confirmed case from the United States with a recently reported novel autoimmune subepidermal bullous disease associated with IgG autoantibodies to a 200 kd dermal antigen.
authors.affiliation: Department of Dermatology, Medical College of Wisconsin, Milwaukee 53226, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Mascaró
authors.forename: D
authors.initials: D
authors.lastname: Zillikens
authors.forename: G J
authors.initials: GJ
authors.lastname: Giudice
authors.forename: F
authors.initials: F
authors.lastname: Caux
authors.forename: M G
authors.initials: MG
authors.lastname: Fleming
authors.forename: H M
authors.initials: HM
authors.lastname: Katz
authors.forename: L A
authors.initials: LA
authors.lastname: Diaz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001323:Autoantibodies / Q000032:analysis*; D001327:Autoimmune Diseases / Q000175:diagnosis*; D001706:Biopsy; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D006801:Humans; D007074:Immunoglobulin G / Q000032:analysis*; D008297:Male; D008970:Molecular Weight; D010391:Pemphigoid, Bullous / Q000175:diagnosis; D012867:Skin / Q000276:immunology* / Q000473:pathology; D012872:Skin Diseases, Vesiculobullous / Q000175:diagnosis*; D014481:United States
chemical_list: D001323:Autoantibodies; D007074:Immunoglobulin G