Linear immunoglobulin A bullous dermatosis associated with herpes simplex virus infection and Kawasaki disease

摘要

Dear Editor, Linear immunoglobulin (lg)A bullous dermatosis (LAD) is an autoimmune subepidermal bullous disease that involves IgA anti-basement membrane antibody and was suggested as an entity by Chorzelski and colleagues in 1979. Its clinical characteristics are vesicles distributed annularly around erythema and/or sparsely distributed tense bullae. Direct immunofluo-rescence (DIF) shows linear deposition of IgA at the basement membrane zone. The pathogenesis of LAD remains unknown. LAD may occur following varicella zoster virus infection, may accompany malignancy and may be drug induced. Kawasaki disease (KD) is an acute febrile eruptive disease that was described in 1967 by Kawasaki and preferentially affects younger children. It is characterized by various kinds of skin rash and systemic vasculitis. The pathogenesis of this disease has been suggested to be a viral infection, such as Epstein-Barr virus or herpes simplex virus (HSV), toxic shock syndrome toxin-1 (TSST-1) and endotoxin from Gram-negative cocci; however, it remains unknown. HSV infection could be causative for both KD and LAD, but their coexistence has not been reported. Recently, Rowley and coworkers reported that IgA plasma cell infiltration is observed at the involved vascular wall in KD patients, and such infiltrates are also seen in unaffected regions, such as the upper respiratory tract, pancreas and kidney. These are interesting findings when considering the coexistence of LAD and KD.