title: Anti-laminin-332 mucous membrane pemphigoid developing after a diphtheria tetanus vaccination.
abstract: OBJECTIVE
  Bullous pemphigoid (BP) has been previously described to develop after vaccination in 26 patients. Immunoblotting or enzyme-linked immunosorbent assays (ELISAs), which were performed for 7 of these patients, have always shown circulating autoantibodies against BP180 and/or BP230 antigens. A case of anti-laminin-332 mucous membrane pemphigoid (MMP) that developed shortly after a diphtheria tetanus vaccination is described, with a review of the literature on postvaccination BP.
  
  
  METHODS
  A 29-year-old man developed an acute eruption of oral and cutaneous blisters and erosions 2 days after receiving a diphtheria tetanus vaccination. The histopathological, immunohistochemical, immunofluorescent, ELISA, and immunoblotting assay results were compatible with anti-laminin-332 MMP. The serum autoantibodies reacted with the α3 and β3 subunits of laminin-332. The disease was controlled by administering a combination of glucocorticosteroids and dapsone.
  
  
  CONCLUSIONS
  The development of acute MMP shortly after a diphtheria tetanus vaccination may have been serendipitous, a result of a nonspecific bystander activation of the immune system, or due to structural mimicry between domains of the toxoid molecule and a subunit of laminin-332.
authors.affiliation: Department of Dermatology, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Tanya
authors.initials: T
authors.lastname: Sezin
authors.forename: Ella
authors.initials: E
authors.lastname: Egozi
authors.forename: Wissam
authors.initials: W
authors.lastname: Hillou
authors.forename: Emily
authors.initials: E
authors.lastname: Avitan-Hersh
authors.forename: Reuven
authors.initials: R
authors.lastname: Bergman
mesh_terms: D000328:Adult; D001323:Autoantibodies / Q000097:blood*; D015815:Cell Adhesion Molecules / Q000276:immunology*; D022422:Diphtheria-Tetanus Vaccine / Q000009:adverse effects*; D003875:Drug Eruptions / Q000276:immunology*; D006801:Humans; D008297:Male; D010390:Pemphigoid, Benign Mucous Membrane / Q000139:chemically induced / Q000188:drug therapy / Q000276:immunology*; D000097794:Kalinin
chemical_list: D001323:Autoantibodies; D015815:Cell Adhesion Molecules; D022422:Diphtheria-Tetanus Vaccine; D000097794:Kalinin