title: A case of epidermolysis bullosa acquisita with autoantibody to anti-p200 pemphigoid antigen and exfoliative esophagitis.
abstract: BACKGROUND
  Some cases of a subepidermal blistering disease associated with autoantibodies to more than two antigens have been reported.
  
  
  METHODS
  A 52-year-old Japanese woman had pruritic blisters on almost the whole body as well as erosive lesions in the oral cavity and esophagus. A histological finding was subepidermal bullae. Direct immunofluorescence (IF) revealed a linear deposition of IgG, IgM and C3 at the epidermal basement membrane zone (BMZ). Indirect IF using human skin split by 1 M NaCl as a substrate showed IgG antibody reactive with the dermal side. By immunoblot analysis using normal human dermal extract, the 200-kDa and 290-kDa bands were detected. Indirect IF did not show any anti-BMZ antibody activity, when using the skin of the patient with recessive dystrophic epidermolysis bullosa as a substrate.
  
  
  CONCLUSIONS
  We regarded our case as epidermolysis bullosa acquisita with autoantibody to anti-p200 pemphigoid antigen. This is the second case in the literature associated with autoantibodies to these two antigens.
authors.affiliation: Department of Dermatology, Jichi Medical School, Tochigi, Japan. tomoko-y@jichi.ac.jp
authors.forename: Tomoko
authors.initials: T
authors.lastname: Yamada
authors.forename: Masayuki
authors.initials: M
authors.lastname: Suzuki
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Koike
authors.forename: Kinuyo
authors.initials: K
authors.lastname: Kida
authors.forename: Satoru
authors.initials: S
authors.lastname: Murata
authors.forename: Norito
authors.initials: N
authors.lastname: Ishii
authors.forename: Takashi
authors.initials: T
authors.lastname: Hashimoto
authors.forename: Mamitaro
authors.initials: M
authors.lastname: Ohtsuki
mesh_terms: D001323:Autoantibodies / Q000276:immunology*; D001324:Autoantigens / Q000276:immunology*; D016107:Epidermolysis Bullosa Acquisita / Q000150:complications / Q000276:immunology*; D004941:Esophagitis / Q000209:etiology / Q000276:immunology*; D005260:Female; D019085:Fluorescent Antibody Technique, Direct; D006801:Humans; D015151:Immunoblotting; D008875:Middle Aged; D010391:Pemphigoid, Bullous / Q000276:immunology*
chemical_list: D001323:Autoantibodies; D001324:Autoantigens