Coexistence of psoriasis and linear IgA bullous dermatosis

Linear IgA bullous dermatosis (LABD) is characterized by IgA autoantibodies against components of the basement membrane zone (BMZ). A 97-kDa protein is one of the major autoantigens associated with this disease. We report a 68-year-old man who developed LABD after a 3-year history of psoriasis and in the context of active hepatitis C virus infection. He had been treated with cyclosporin for psoriasis for about 9 months. Histologically, there was a subepidermal blister containing neutrophils and eosinophils with lymphocytes infiltrating predominantly in the dermis. Direct immunofluorescent staining showed linear IgA deposition at the BMZ. The patient's IgA autoantibodies bound exclusively to the epidermal side of 1 mol/L salt-split normal human skin. Immunoblot analysis identified a 97-kDa autoantigen in epidermal extracts. This appears to be the first case of LABD with IgA autoantibodies against a 97-kDa autoantigen, associated with psoriasis and hepatitis C virus infection.     

Sarcoidosis in a patient with linear IgA disease

We report a patient with four conditions in association with linear IgA disease (LAD), only three of which have been reported previously; these latter are ulcerative colitis, autoimmune thyroid disease and carcinoma of the colon, although the carcinoma may have been caused by the ulcerative colitis in this case. Recently, our patient also presented with respiratory symptoms and was found to have sarcoidosis as well, a previously unreported association of this autoimmune bullous disorder. The aetiology of this development may be related to the patient's HLA status or possibly to his treatment with the immunosuppressive agent cyclophosphamide; it is also possible that it is coincidental.     

Localized linear IgA dermatosis induced by UV light-treatment for herpes zoster

We report a case of localized linear IgA dermatosis (LID). The patient suffered from herpes zoster on the right waist and received three localized ultraviolet (UV) light treatments. One month later he presented with bullae on the same site. Direct immunofluorescence showed deposition of linear IgA and weak C3 along the basement membrane zone. Indirect immunofluorescence on the salt-split human skin demonstrated that IgA antibodies were bound to the epidermal side. To our knowledge, this is the first case of localized LID induced by UV light treatment for herpes zoster. It is also the third case of LID induced by UV light.     

Atypical herpes zoster in a patient with AIDS

Objective To report a case of persistent infection by varicella-zoster virus (VZV) in an HIV-infected patient who presented with atypical, hyperkeratotic viral lesions and a partial response to acyclovir. Methods Viral changes found on histopathological examination; definitive diagnosis of VZV infection was established by viral culture. Results Lesions of chronic hyperkeratotic herpes zoster responded partially to acyclovir therapy, and complete resolution was achieved with intravenous foscarnet. Absence of visceral involvement. Conclusion Prolonged acyclovir therapy for herpes virus infections in HIV-seropositive patients may represent an important pathogenic factor for the appearance of atypical clinical forms associated with drug-resistant viral strains.     

A case of linear IgA disease occurring in a patient with colonic Crohn's disease

Linear IgA disease has been reported in association with inflammatory bowel disease, in particular ulcerative colitis. We experienced a case of linear IgA disease that occurred simultaneously with colonic Crohn's disease in a 55-year-old woman and rather unusually both skin and bowel disease improved in tandem. We report the presentation, investigations and subsequent improvement of our patient and speculate on possible causes.     

Leishmania infection occurring in herpes zoster lesions in an HIV-positive patient

Summary We report the first case of co-infection with herpes zoster and leishmania in the same lesion, on the face of a 29-year-old female, who was an intravenous drug user and who was HIV positive. The infection was initially resistant to acyclovir and itraconazole, and the patient died due to severe infection in the Mediterranean countries is increasing among the HIV-positive population because of the existence of human carriers. Paradoxically, most of these patients show mild forms of visceral leishmaniasis.     

Unusual varicella zoster virus infection in a patient with colon carcinoma and Evans syndrome--delayed virus shedding generalized recurrent necrotic herpes zoster

A 53-year-old Japanese woman with Evans syndrome and colon cancer had two episodes of herpes zoster. The first painful vesicular rashes involved the right lower abdomen and buttock and healed in one month. After one more month, a second attack occurred on the right thigh and leg and developed into generalized hemorrhagic lesions, which became crusted in about 90 days. The patient died 131 days after the second attack, when the lesions had almost subsided. Varicella-zoster virus (VZV) was isolated on the 59th day of the second attack. Her intracutaneous reactions to VZV antigen was negative, but the humoral antibodies were continuously positive.     

寻常性银屑病并发成人型线状IgA大疱性皮病

报告l例寻常性银屑病并发成人型线状IgA大疱性皮病.患者男,36岁.因全身红色斑疹伴白色鳞屑反复发生20年.躯干、双上肢出现环状排列的水疱10d伴瘙痒就诊.皮损组织病理检查:表皮下水疱,疱内、真皮浅层和真皮乳头见中性粒细胞、嗜酸性粒细胞浸润;皮损周围皮肤直接免疫荧光显示基膜带Iga、IgG呈带状沉积;取患者血清行BP180NC16A(大疱性类天疱疮18 000抗原的近膜片段)-ELISA检查显示阴性;以盐裂正常人皮肤为底物,取患者血清行间接免疫荧光检查显示IgA、IgG呈带状沉积在真皮侧.诊断为寻常性银屑病并发成人型线状TgA大疱性皮病.     

Dapsone-induced photodermatitis in a patient with linear IgA dermatosis

Dapsone (4, 4' diaminodiphenylsulfone) is an efficient antiinflammatory agent. Its therapeutic use may result in a variety of adverse effects. The most frequent unwanted reactions are hemolytic anemia and methemoglobinemia. By oral route dapsone is mainly metabolized to monoacetyldapsone (MADDS) and hydroxylamine dapsone (DDS-NOH). We report a 76-year-old female patient with linear IgA dermatosis who developed a dapsone-induced photosensitivity 8 weeks after initiation of sulfone therapy. She showed a widespread erythematous eruption in UV-exposed skin area. After clearing of skin lesions the photopatch test revealed positive reactions to dapsone, MADDS and DDS-NOH. Dapsone-induced photosensitivity to date has been described only in leprosy patients. We demonstrate for the first time that this adverse reaction is not restricted to leprosy and that dapsone metabolites may also contribute to the mechanism of photosensitivity like the parent sulfone. Dapsone-induced photosensitivity is a rare, not dose-related adverse effect of the sulfone and can also occur in patients with inflammatory skin disorders.     

The generalized form of herpes zoster in a patient with mycosis fungoides

The described case is marked for a dissemination of the skin process, its severity, and manifest intoxication. A considerable reduction of the body reactivity because of mycosis fungoides is responsible for the development of the generalized process; another reason is prolonged intake of corticosteroids and cytostatics for the underlying condition.     

Coexistent granulomatous vasculitis and leukaemia cutis in a patient with resolving herpes zoster

An 80-year-old man presented with a 6-month history of indurated tender purple papules. These had coalesced to form plaques with some central scarring and a dermatomal distribution on the left arm, immediately following herpes zoster (HZ) infection at this site. The patient had a 5-year history of small lymphocytic lymphoma (SLL), which was being managed conservatively under a 'watch and wait' protocol. On histological examination of a skin biopsy, marked interstitial granulomas and prominent granulomatous vasculitis were seen, supporting the clinical impression of a post-HZ granulomatous reaction. In addition, there was a dense monoclonal small B-cell lymphocytic infiltrate indicating koebnerization by SLL (a finding that has not been reported previously with concurrent postherpetic granulomatous vasculitis). Although benign pseudolymphomas occur in postherpetic cases, this case shows that even in association with benign vasculitic features true lymphomas can occur. Furthermore, this case highlights the importance of immunocytochemistry, molecular studies and clinicopathological correlation.     

Linear IgA disease in a patient with Castleman's disease

Linear IgA disease (LAD) is a well recognized subepidermal blistering disorder characterized by linear deposits of IgA at the basement membrane zone. The aetiology is unknown but there is a recognized association with lymphoproliferative malignancies. We report a case of LAD occurring in a patient with multicentric Castleman's disease (angiofollicular lymph node hyperplasia), an association not previously recorded in the literature.     

肺癌术后放化疗并发泛发性带状疱疹1例

报告１例６０岁男性患者,３周前右季肋区出现疼痛性水疱,２周前皮损全身泛发,伴高热。患者１年前行右肺癌根治术,术后一直接受Ｘ线放射治疗和化疗,此次皮损播散发生于例行化疗的第２ｄ,提示发病与肿瘤放化疗造成的免疫抑制相关。治疗应及时给予大剂量无环鸟苷和支持疗法。