The Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York, USA.
J Cutan Pathol. 2023 Jan;50(1):24-28. doi: 10.1111/cup.14305. Epub 2022 Aug 23.
We present a case of eosinophil-rich linear IgA bullous disease (LABD) following the administration of a messenger RNA COVID-19 booster vaccine. A 66-year-old man presented to the emergency department with a 3-week history of a pruritic blistering rash characterized by fluid-filled bullae and multiple annular and polycyclic plaques. He was initially diagnosed with bullous pemphigoid based on a biopsy showing a subepidermal blister with numerous eosinophils. However, direct immunofluorescence studies showed linear IgA and IgM deposition along the basement membrane zone with no immunoreactivity for C3 or IgG. Additionally, indirect immunofluorescence was positive for IgA basement membrane zone antibody. The patient was subsequently diagnosed with LABD and initiated on dapsone therapy with resolution of his lesions at 3-month follow-up. This case illustrates the growing number of autoimmune blistering adverse cutaneous reactions from vaccination. Dermatopathologists should be aware that features of autoimmune blistering diseases can overlap and may not be distinguishable based on these histopathological findings alone. Confirmation with direct immunofluorescence and/or serological studies may be necessary for accurate diagnosis.
我们报告了一例在接种信使 RNA COVID-19 加强疫苗后出现嗜酸性粒细胞丰富的线性 IgA 大疱性皮肤病 (LABD) 的病例。一名 66 岁男性因瘙痒性水疱性皮疹就诊于急诊科，该皮疹的特征为充满液体的大疱和多个环形和多环斑块。最初根据活检显示表皮下水疱伴大量嗜酸性粒细胞，诊断为大疱性类天疱疮。然而，直接免疫荧光研究显示沿基底膜带呈线性 IgA 和 IgM 沉积，C3 或 IgG 无免疫反应性。此外，间接免疫荧光 IgA 基底膜带抗体阳性。随后诊断为 LABD，并开始用氨苯砜治疗，在 3 个月随访时皮损得到缓解。该病例说明了越来越多的与疫苗接种相关的自身免疫性大疱性皮肤不良反应。皮肤科病理学家应该意识到，自身免疫性大疱性疾病的特征可能重叠，仅根据这些组织病理学发现可能无法区分。可能需要直接免疫荧光和/或血清学研究来进行准确诊断。
