Ann Dermatol.  2015 Jun;27(3):315-318. 10.5021/ad.2015.27.3.315.

Concurrent Drug-Induced Linear Immunoglobulin A Dermatosis and Immunoglobulin A Nephropathy

• Kim JS
• Choi M
• Nam CH
• Kim JY
• Park BC
• Kim MH
• Hong SP

• KMID: 2352504
• DOI: http://doi.org/10.5021/ad.2015.27.3.315

Abstract

Diseases associated with immunoglobulin A (IgA) antibody include linear IgA dermatosis, IgA nephropathy, Celiac disease, Henoch-Schonlein purpura, etc. Although usually idiopathic, IgA antibody is occasionally induced by drugs (e.g., vancomycin, carbamazepine, ceftriaxone, and cyclosporine), malignancies, infections, and other causes. So far, only a few cases of IgA bullous dermatosis coexisting with IgA nephropathy have been reported. A 64-year-old female receiving intravenous ceftriaxone and metronidazole for liver abscess had purpuric macules and papules on her extremities. One week later, she had generalized edema and skin rash with bullae and was diagnosed with concurrent linear IgA dermatosis and IgA nephropathy. After steroid treatment, the skin lesion subsided within two weeks, and kidney function slowly returned to normal. As both diseases occurred after a common possible cause, we predict their pathogeneses are associated.

Keyword

Glomerulonephritis; Immunoglobulin A; Linear IgA bullous dermatosis; Drug eruptions

MeSH Terms

Carbamazepine
Ceftriaxone
Celiac Disease
Drug Eruptions
Edema
Exanthema
Extremities
Female
Glomerulonephritis
Glomerulonephritis, IGA*
Humans
Immunoglobulin A*
Kidney
Linear IgA Bullous Dermatosis
Liver Abscess
Metronidazole
Middle Aged
Purpura, Schoenlein-Henoch
Skin
Skin Diseases*
Vancomycin
Carbamazepine
Ceftriaxone
Immunoglobulin A
Metronidazole
Vancomycin

Figure

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  Fig. 1 Multiple scattered bullae on an erythematous base on the nape (A) and back (B) (arrow: biopsy site).

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  Fig. 2 (A) Subepidermal blister with inflammatory cell infiltration (H&E, ×100). (B) Polymorphonuclear leukocytes and few lymphocytes along the interface of the subepidermal blister and papillary dermis (H&E, ×400). (C) Linear deposition of immunoglobulin A along basement membrane (direct immunofluorescence, ×100).

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  Fig. 3 (A) Glomerulus with mesangial proliferation and expansion of the mesangial matrix with mildly increased cellularity (H&E, ×400). (B) Direct immunofluorescence demonstrating diffuse mesangial immunoglobulin A deposits (×400).

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