May Bacterial Infections Trigger Bullous Pemphigoid? Case Report and Review of Literature
Bullous pemphigoid (BP) is an autoimmune blistering skin disease, mainly observed in the elderly. Infections have been suggested as possible disease triggers. However, infections may even heavily influence the disease clinical course and mortality. A 75-year-old woman was admitted to hospital for se...
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-06-01
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| Series: | Microorganisms |
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| Online Access: | https://www.mdpi.com/2076-2607/9/6/1235 |
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| author | Michela Ileen Biondo Chiara Fiorentino Severino Persechino Antonella Tammaro Angela Koverech Armando Bartolazzi Salvatore Raffa Marco Canzoni Andrea Picchianti-Diamanti Roberta Di Rosa Giovanni Di Zenzo Enrico Scala Giorgia Meneguzzi Claudia Ferlito Milica Markovic Sara Caporuscio Maria Laura Sorgi Simonetta Salemi Bruno Laganà |
| author_facet | Michela Ileen Biondo Chiara Fiorentino Severino Persechino Antonella Tammaro Angela Koverech Armando Bartolazzi Salvatore Raffa Marco Canzoni Andrea Picchianti-Diamanti Roberta Di Rosa Giovanni Di Zenzo Enrico Scala Giorgia Meneguzzi Claudia Ferlito Milica Markovic Sara Caporuscio Maria Laura Sorgi Simonetta Salemi Bruno Laganà |
| author_sort | Michela Ileen Biondo |
| collection | DOAJ |
| description | Bullous pemphigoid (BP) is an autoimmune blistering skin disease, mainly observed in the elderly. Infections have been suggested as possible disease triggers. However, infections may even heavily influence the disease clinical course and mortality. A 75-year-old woman was admitted to hospital for severe erythematosus blistering disease, accompanied by hyper-eosinophilia and hyper-IgE. The culture of bullous fluid was positive for <i>Enterococcus faecalis</i>, the blood culture was positive for <i>Staphylococcus aureus</i>, and the urine culture was positive for <i>Proteus mirabilis</i> and <i>Escherichia coli.</i> Moreover, circulating anti-BP180 IgG was present and the histopathological/ultrastructural examination of a lesional skin biopsy was compatible with BP. High eosinophil levels (up to 3170/µL) were found throughout the clinical course, while values below 1000/µL were associated with clinical improvement. The total IgE was 1273 IU/mL, and specific anti-G/V-penicillin/ampicillin IgE antibodies were positive. The patient had a complete clinical recovery in two months with methyl-prednisolone (40 then 20 mg/day) and low-dose azathioprine (50 mg/day) as a steroid-sparing agent. The steroid treatment was tapered until interruption during a one-year period and intravenous immunoglobulins have been administered for three years in order for azathioprine to also be interrupted. The patient stopped any treatment five years ago and, in this period, has always been in good health. In this case, the contemporaneous onset of different bacterial infections and BP is suggestive of bacterial infections acting as BP trigger(s), with allergic and autoimmune pathways contributing to the disease pathogenesis. |
| first_indexed | 2024-03-10T10:38:51Z |
| format | Article |
| id | doaj.art-33270419636945cb9a8e5e053ee4998a |
| institution | Directory Open Access Journal |
| issn | 2076-2607 |
| language | English |
| last_indexed | 2024-03-10T10:38:51Z |
| publishDate | 2021-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Microorganisms |
| spelling | doaj.art-33270419636945cb9a8e5e053ee4998a2023-11-21T23:04:14ZengMDPI AGMicroorganisms2076-26072021-06-0196123510.3390/microorganisms9061235May Bacterial Infections Trigger Bullous Pemphigoid? Case Report and Review of LiteratureMichela Ileen Biondo0Chiara Fiorentino1Severino Persechino2Antonella Tammaro3Angela Koverech4Armando Bartolazzi5Salvatore Raffa6Marco Canzoni7Andrea Picchianti-Diamanti8Roberta Di Rosa9Giovanni Di Zenzo10Enrico Scala11Giorgia Meneguzzi12Claudia Ferlito13Milica Markovic14Sara Caporuscio15Maria Laura Sorgi16Simonetta Salemi17Bruno Laganà18Dipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, ItalyDipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, ItalyUOD di Dermatologia, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, ItalyUOD di Dermatologia, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, ItalyDipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, ItalyDipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, ItalyDipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, ItalyDipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, ItalyDipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, ItalyDipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, ItalyIstituto Dermopatico dell’Immacolata, 00167 Roma, ItalyIstituto Dermopatico dell’Immacolata, 00167 Roma, ItalyDipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, ItalyDipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, ItalyDipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, ItalyDipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, ItalyDipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, ItalyDipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, ItalyDipartimento di Medicina Clinica e Molecolare, Sapienza, Università di Roma, AOU S. Andrea, 00189 Roma, ItalyBullous pemphigoid (BP) is an autoimmune blistering skin disease, mainly observed in the elderly. Infections have been suggested as possible disease triggers. However, infections may even heavily influence the disease clinical course and mortality. A 75-year-old woman was admitted to hospital for severe erythematosus blistering disease, accompanied by hyper-eosinophilia and hyper-IgE. The culture of bullous fluid was positive for <i>Enterococcus faecalis</i>, the blood culture was positive for <i>Staphylococcus aureus</i>, and the urine culture was positive for <i>Proteus mirabilis</i> and <i>Escherichia coli.</i> Moreover, circulating anti-BP180 IgG was present and the histopathological/ultrastructural examination of a lesional skin biopsy was compatible with BP. High eosinophil levels (up to 3170/µL) were found throughout the clinical course, while values below 1000/µL were associated with clinical improvement. The total IgE was 1273 IU/mL, and specific anti-G/V-penicillin/ampicillin IgE antibodies were positive. The patient had a complete clinical recovery in two months with methyl-prednisolone (40 then 20 mg/day) and low-dose azathioprine (50 mg/day) as a steroid-sparing agent. The steroid treatment was tapered until interruption during a one-year period and intravenous immunoglobulins have been administered for three years in order for azathioprine to also be interrupted. The patient stopped any treatment five years ago and, in this period, has always been in good health. In this case, the contemporaneous onset of different bacterial infections and BP is suggestive of bacterial infections acting as BP trigger(s), with allergic and autoimmune pathways contributing to the disease pathogenesis.https://www.mdpi.com/2076-2607/9/6/1235bullous pemphigoid (BP)infectionsautoimmunityIVIg |
| spellingShingle | Michela Ileen Biondo Chiara Fiorentino Severino Persechino Antonella Tammaro Angela Koverech Armando Bartolazzi Salvatore Raffa Marco Canzoni Andrea Picchianti-Diamanti Roberta Di Rosa Giovanni Di Zenzo Enrico Scala Giorgia Meneguzzi Claudia Ferlito Milica Markovic Sara Caporuscio Maria Laura Sorgi Simonetta Salemi Bruno Laganà May Bacterial Infections Trigger Bullous Pemphigoid? Case Report and Review of Literature Microorganisms bullous pemphigoid (BP) infections autoimmunity IVIg |
| title | May Bacterial Infections Trigger Bullous Pemphigoid? Case Report and Review of Literature |
| title_full | May Bacterial Infections Trigger Bullous Pemphigoid? Case Report and Review of Literature |
| title_fullStr | May Bacterial Infections Trigger Bullous Pemphigoid? Case Report and Review of Literature |
| title_full_unstemmed | May Bacterial Infections Trigger Bullous Pemphigoid? Case Report and Review of Literature |
| title_short | May Bacterial Infections Trigger Bullous Pemphigoid? Case Report and Review of Literature |
| title_sort | may bacterial infections trigger bullous pemphigoid case report and review of literature |
| topic | bullous pemphigoid (BP) infections autoimmunity IVIg |
| url | https://www.mdpi.com/2076-2607/9/6/1235 |
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