Yonsei Med J.  2006 Apr;47(2):278-281. 10.3349/ymj.2006.47.2.278.

Transition from Pemphigus Foliaceus to Pemphigus Vulgaris: Case Report with Literature Review

• Park SG
• Chang JY
• Cho YH
• Kim SC
• Lee MG

• KMID: 1110756
• DOI: http://doi.org/10.3349/ymj.2006.47.2.278

Abstract

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.

Keyword

Pemphigus; western blotting

MeSH Terms

Time Factors
Steroids/therapeutic use
Skin/pathology
Pemphigus/*diagnosis/pathology
Middle Aged
Male
Immunoglobulin G/chemistry
Immunoblotting
Humans
Fluorescent Antibody Technique, Indirect
Female
Disease Progression
Cell Membrane/metabolism
Blotting, Western
Azathioprine/therapeutic use
Autoantigens/chemistry
Autoantibodies/chemistry
Aged
Adult

Figure

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  Fig. 1 Histologic features of vesicles. Subcorneal acantholysis in the PF stage (A). Suprabasal acantholysis in the PV stage (B). (Hematoxylin & Eosin, × 100).

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  Fig. 2 The results of the immunoblot assay. The reference serum of the patient with PV (lane 1) and PF (lane 2) reacted with 130 kDa protein and 160 kDa protein, respectively. The 5 year-old serum of our patient with the PF stage showed a negative result (lane 3), whereas the serum of the PV stage reacted with 130 kDa and 160 kDa proteins (lane 4).

Reference

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