Dermatology Department, Saint-Louis Hospital, 1 Avenue Claude Vellefaux, 75010, Paris, France.
Paris VII Sorbonne Paris Cité University, Paris, France.
Br J Dermatol. 2018 Feb;178(2):547-550. doi: 10.1111/bjd.15496. Epub 2017 Oct 17.
Orf is a DNA parapoxvirus transmitted to humans by contact with infected goats and sheep. Many complications have been reported after orf infection, including erythema multiforme. A few cases of autoimmune bullous dermatosis complicating orf disease have been reported to date. They are usually characterized by tense blister eruptions with or without mucosal involvement; linear deposition of C3, IgG and/or IgA along the basement membrane; and negativity of indirect immunofluorescence analysis and enzyme-linked immunosorbent assay (ELISA) (performed in four of 11 reported cases). These analyses have targeted antigens of bullous pemphigoid, mucous membrane pemphigoid or epidermolysis bullosa acquisita, except one case of mucosal pemphigoid with antilaminin-332 antibodies. We describe the case of a patient who presented with an ulceration on his finger 10 days after direct contact with a lamb during Eid al-Adha. Four weeks later he developed a severe tense blistering eruption associated with mucous membrane erosions. Indirect immunofluorescence analysis using the patient's serum revealed circulating antibasement membrane IgG that bound the dermal side of salt-split skin. ELISA was positive for recombinant immunodominant NC1 domain of type VII collagen. We finally diagnosed epidermolysis bullosa acquisita complicating probable human orf infection.
羊痘是一种由感染的山羊和绵羊通过接触传播给人类的 DNA 副痘病毒。感染羊痘后会出现许多并发症，包括多形红斑。迄今为止，已有少数自身免疫性大疱性皮肤病并发羊痘的病例报告。它们通常表现为紧张性水疱性皮疹，伴或不伴有黏膜受累；沿基底膜线状沉积 C3、IgG 和/或 IgA；间接免疫荧光分析和酶联免疫吸附试验（ELISA）均为阴性（在 11 例报告病例中的 4 例中进行）。这些分析的靶抗原为大疱性类天疱疮、黏膜性类天疱疮或获得性大疱性表皮松解症，除了一例抗层粘连蛋白 332 抗体的黏膜性类天疱疮。我们描述了一例患者的病例，他在宰牲节期间直接接触羔羊 10 天后手指出现溃疡，4 周后他出现严重的紧张性水疱性皮疹，并伴有黏膜糜烂。使用患者血清进行间接免疫荧光分析显示循环抗基底膜 IgG 结合盐裂皮肤的真皮侧。ELISA 对重组免疫显性 VII 型胶原 NC1 结构域呈阳性。我们最终诊断为获得性大疱性表皮松解症并发可能的人类羊痘感染。
