Ocular involvement in anti-epiligrin cicatricial pemphigoid.
OBJECTIVE
To report an anti-epiligrin cicatricial pemphigoid (AECP) patient with severe ocular involvement and to provide a practical approach to distinguishing AECP patients from those with other subepidermal blistering diseases.


METHODS
Techniques included direct and indirect immunofluorescence microscopy, Western blot and immunoprecipitation studies, as well as interdisciplinary examinations of mucous membranes and skin.


RESULTS
This study describes a patient with clinical features of cicatricial pemphigoid, circulating anti-basement membrane zone IgG antibodies, and subepidermal blisters. Histopathology and immunofluorescence analysis suggested the diagnosis of a cicatricial pemphigoid-like type of epidermolysis bullosa acquisita. However, Western blot and immunoprecipitation studies demonstrated that the patient's serum contained autoantibodies against laminin 5 alpha3 subunit, leading to the diagnosis of an AECP.


CONCLUSIONS
Since patients with AECP have an increased relative risk for malignant tumors, it is important to distinguish this entity within the spectrum of cicatricial pemphigoid patients by additional studies such as Western blot or immunoprecipitation.
Nischler
C
C
Department of Ophthalmology, Paracelsus Private Medical University Salzburg, Salzburg, Austria. c.nischler@salk.at
Sadler
E
E
Lazarova
Z
Z
Stoiber
J
J
Ruckhofer
J
J
Pohla-Gubo
G
G
Emberger
M
M
Bauer
J W
JW
Grabner
G
G
Hintner
H
H
D001323:Autoantibodies / Q000097:blood*; D001327:Autoimmune Diseases / Q000175:diagnosis / Q000276:immunology*; D015153:Blotting, Western; D015815:Cell Adhesion Molecules / Q000097:blood*; D003229:Conjunctival Diseases / Q000175:diagnosis / Q000276:immunology*; D016107:Epidermolysis Bullosa Acquisita / Q000175:diagnosis / Q000276:immunology; D005260:Female; D019085:Fluorescent Antibody Technique, Direct; D019084:Fluorescent Antibody Technique, Indirect; D006801:Humans; D007074:Immunoglobulin G / Q000032:analysis; D008875:Middle Aged; D009092:Mucous Membrane; D010390:Pemphigoid, Benign Mucous Membrane / Q000175:diagnosis / Q000276:immunology*; D012867:Skin / Q000378:metabolism; D000097794:Kalinin
D001323:Autoantibodies; D015815:Cell Adhesion Molecules; D007074:Immunoglobulin G; D000097794:Kalinin