Foureur N, Descamps V, Lebrun-Vignes B, Picard-Dahan C, Grossin M, Belaich S, Crickx B
Department of Dermatology, Bichat-Claude-Bernard Hospital, 46, rue Henri-Huchard 75018 Paris, France.
Eur J Dermatol. 2001 May-Jun;11(3):230-3.
We report a typical case of bullous pemphigoid (BP) associated with a neurological disorder and study a possible link between neurological disorders and BP. An 84-year-old hemiplegic woman presented with unilateral BP on the hemiparetic side. BP was confirmed by histological and immunofluorescence data. The medical records of the previous 46 consecutive patients with BP were retrospectively analyzed (average age: 79; median age: 85). Thirty of the 46 patients with BP had neurological disorders. These disorders included dementia, epilepsy, multiple sclerosis, cerebral stroke, Parkinson's disease, gonadotropic adenoma, trembling, dyskinesia, lumbar spinal stenosis. In a control group of the 46 consecutive oldest patients (older than 71; average age: 82,5; median age: 80) with another skin disease referred during the previous two-year-period to our one-day-unit only, 13 patients had a neurological disorder. This study demonstrates that there is a high prevalence of neurological disorders in patients with BP (p = 0.0004). A prospective case control study with neurological examination and psychometrical evaluation is warranted to confirm these data. We speculate that neuroautoimmunity associated with the aging process or neurological disorders may be involved in pemphigoid development via an autoimmune response against dystonin which shares homology with bullous pemphigoid antigen 1. Bullous pemphigoid could be considered to be a marker of neurological disorder.
我们报告了一例典型的大疱性类天疱疮(BP)合并神经系统疾病的病例,并研究了神经系统疾病与BP之间可能存在的联系。一名84岁的偏瘫女性,在偏瘫侧出现单侧BP。通过组织学和免疫荧光数据确诊为BP。对之前连续46例BP患者的病历进行回顾性分析(平均年龄:79岁;中位年龄:85岁)。46例BP患者中有30例患有神经系统疾病。这些疾病包括痴呆、癫痫、多发性硬化症、脑卒、帕金森病、促性腺激素腺瘤、震颤、运动障碍、腰椎管狭窄。在一个对照组中,选取了连续46例年龄最大的患者(年龄大于71岁;平均年龄:82.5岁;中位年龄:80岁),这些患者在过去两年中仅因另一种皮肤病被转诊至我们的单日病房,其中13例患有神经系统疾病。本研究表明,BP患者中神经系统疾病的患病率较高(p = 0.0004)。有必要进行一项前瞻性病例对照研究,进行神经系统检查和心理测量评估以证实这些数据。我们推测,与衰老过程或神经系统疾病相关的神经自身免疫可能通过针对与大疱性类天疱疮抗原1具有同源性的桥粒斑蛋白的自身免疫反应参与类天疱疮的发展。大疱性类天疱疮可被视为神经系统疾病的一个标志物。