Atypical pemphigus with anti-desmocollin 2 and 3 antibodies, initially presenting as pemphigus vulgaris with anti-desmog
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Correspondence
CORRESPONDENCE Atypical pemphigus with anti-desmocollin 2 and 3 antibodies, initially presenting as pemphigus vulgaris with anti-desmoglein 3 antibodies A 51-year-old Japanese man presented with a two-month history of erosions on the oral mucosa and blisters on the
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doi:10.1684/ejd.2020.3819
trunk. Physical examination revealed multiple erosions on the soft plate and buccal mucosa, and flaccid and/or tense bullae on the trunk (figure 1A, B). Histopathological examinations revealed suprabasal acantholytic blisters with infiltration of eosinophils and a small number of neutrophils (figure 1C). Direct immunofluorescence (DIF) staining showed IgG and C3 deposition on keratinocyte cell surfaces (figure 1D). IgA deposition was not detected. Chemiluminescent enzyme immunoassay
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Figure 1. Clinical, histopathological and immunofluorescence features. A-D) Features at the initial stage: A) oral mucosal erosions; B) blisters on the trunk; C) intraepidermal acantholytic bullae with numerous eosinophils (haematoxylin and eosin [H&E] stain; original magnification: ×40). D) IgG deposition on keratinocyte surfaces by direct immunofluorescence staining. E, F) Features at the recurrent stage: E) flaccid blisters and pustules in recurrent lesions; F) suprabasal acantholysis with intraepidermal eosinophil and lymphocyte infiltration (H&E stain; original magnification: ×100). EJD, vol. 30, n◦ 4, July-August 2020
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(CLEIA) revealed high levels of anti-desmoglein (Dsg)3 IgG antibodies (1,460 U/mL; normal < 20.0 U/mL). Negative results were obtained for anti-Dsg1 IgG antibodies (
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