Pemphigus Vulgaris Following Influenza: A Case Report

Main Article Content

Kristen Bice
Channing Hood
Rawaa Almukhtar
Michelle Gerdes
Pamela Martin
Brian Lee

Keywords

pemphigus vulgaris, molecular mimicry, epitope spreading

Abstract

Viruses have long been implicated as potential triggers of autoimmune disease. In the case of pemphigus vulgaris, members of the herpesviridae family are often associated with its development. There have also been reports of pemphigus being triggered by the influenza vaccine. We report a case of a 17-year-old male who developed mucous membrane-predominant pemphigus vulgaris after testing positive for the influenza virus and discuss proposed hypotheses for the association between viral infections and autoimmunity, such as molecular mimicry and epitope spreading.

References

1. Ruocco E, Ruocco V, Lo Schiavo A, Brunetti G, Wolf R. Viruses and pemphigus. An intriguing never-ending story. Dermatology. 2014;229(4):310-5.

2. Chan LS, Vanderlugt CJ, Hashimoto T, Nishikawa T, Zone JJ, Black MM, et al. Epitope spreading. Lessons from autoimmune skin disease. J Invest Dermatol. 1998;110(2):103-9.

3. Tchernev G, Orfanos CE. Antigen mimicry, epitope spreading and the pathogenesis of pemphigus. Tissue Antigens. 2006 Oct;68(4):280-6.

4. Ramseur WL, Richards F II, Duggan DB: A case of fatal pemphigus vulgaris in association with beta interferon and interleukin-2 therapy. Cancer. 1989;63(10):2005–7.

5. Kirsner RS, Anhalt GJ, Kerdel FA. Treatment with alpha interferon associated with the development of paraneoplastic pemphigus. Br J Dermatol. 1995;132(3):474–478.

6. Parodi A, Semino M, Gallo R, Rebora A. Bullous eruption with circulating pemphigus-like antibodies following interferon-alpha therapy. Dermatology. 1993;186(2):155–7.

7. Centers for Disease Control and Prevention. Rapid Diagnostic Testing for Influenza: Information for Clinical Laboratory Directors. March 6, 2018; Available from: https://www.cdc.gov/flu/professionals/diagnosis/rapidlab.htm.

8. Mignogna MD, Lo Muzio L, Ruocco E. Pemphigus induction by influenza vaccination. Int J Dermatol. 2000;39(10):800.

9. Giles JA, Orozco SH, Nava LA, Hernandez VJ. Pemphigus vulgaris induced by seasonal anti-influenza vaccine. Dermatologia Revista Mexicana. 2012;56(5):323-326.

10. Sinha P, Chatterjee M, Vasudevan B. Pemphigus vulgaris: A dermatological sequel of severe H1N1 infection. Indian Dermatol Online J. 2014;5(2):216-217.