Transition from pemphigus foliaceus to pemphigus vulgaris: case report with literature review.
The transition between the main subtypes of pemphigus, pemphigus vulgaris (PV), and pemphigus foliaceus (PF) has rarely been reported. Moreover, the development of PV in a patient with PF is much more unusual than that of PF in a patient with PV. We report a 48-year-old man who presented with cutaneous lesions showing the typical clinical and histological features of PF. Five years later, his skin lesions became extensive and he developed oral erosions. His condition did not respond well to steroids and azathioprine. Histological examination of a vesicle disclosed suprabasal acantholysis in contrast to the subcorneal acantholysis discovered upon initial histological evaluation. Indirect immunofluorescence revealed IgG antikeratinocyte cell surface antibodies at a titer of 1:640. The titer was 1:160 at initial diagnosis. Upon immunoblotting, the patient's serum reacted with 130 kiloDalton (kDa) and 160 kDa proteins, suggesting desmoglein (Dsg) 3 and 1, respectively. We herein report an unusual case of PV that developed from PF during the disease's flare-up.
Park
Sang Gun
SG
Department of Dermatology, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemoon-gu, Seoul 120-752, Korea.
Chang
Jae Yong
JY
Cho
Young-Hun
YH
Kim
Soo-Chan
SC
Lee
Min-Geol
MG
D000328:Adult; D000368:Aged; D001323:Autoantibodies / Q000737:chemistry; D001324:Autoantigens / Q000737:chemistry; D001379:Azathioprine / Q000627:therapeutic use; D015153:Blotting, Western; D002462:Cell Membrane / Q000378:metabolism; D018450:Disease Progression; D005260:Female; D019084:Fluorescent Antibody Technique, Indirect; D006801:Humans; D015151:Immunoblotting; D007074:Immunoglobulin G / Q000737:chemistry; D008297:Male; D008875:Middle Aged; D010392:Pemphigus / Q000175:diagnosis* / Q000473:pathology; D012867:Skin / Q000473:pathology; D013256:Steroids / Q000627:therapeutic use; D013997:Time Factors
D001323:Autoantibodies; D001324:Autoantigens; D007074:Immunoglobulin G; D013256:Steroids; D001379:Azathioprine