Funding sources: Georgia Dermatopathology Associates (GDA; Dr Howard) and the Embassy of Japan in Colombia, Medellin, Colombia, SA (Dr Abreu Velez).
Varicella-zoster virus (VZV) and alpha 1 antitrypsin: a fatal outcome in a patient affected by endemic pemphigus foliaceus
Article first published online: 20 JUN 2012
© 2012 The International Society of Dermatology
International Journal of Dermatology
Volume 51, Issue 7, pages 809–816, July 2012
How to Cite
Abreu Velez, A. M., Smoller, B. R., Gao, W., Grossniklaus, H. E., Jiao, Z., Arias, L. F., Dudley, S. C. and Howard, M. S. (2012), Varicella-zoster virus (VZV) and alpha 1 antitrypsin: a fatal outcome in a patient affected by endemic pemphigus foliaceus. International Journal of Dermatology, 51: 809–816. doi: 10.1111/j.1365-4632.2011.05296.x
Conflict of interest: none.
- Issue published online: 20 JUN 2012
- Article first published online: 20 JUN 2012
Background Herpes virus infections are well known infectious complications of pemphigus and bullous pemphigoid. We describe pathologic findings utilizing autopsy tissue from several organs from a patient affected by a new variant of endemic pemphigus in El Bagre, Colombia, South America.
Case report We describe a patient by a new variant of endemic pemphigus foliaceus from El Bagre that was receiving high-dosage immunosuppressants when hospitalized and died suddenly following contact with a second patient affected by chicken pox.
Materials and methods We performed studies utilizing hematoxylin and eosin, immunohistochemistry, and direct immunofluorescence techniques on tissues from several organs.
Results We detected the presence of varicella zoster virus, as well as strong positivity for α-1 antitrypsin in the heart, kidneys, spleen, liver, skin, brain, lungs, pancreas, small and large intestines, and skeletal muscle. In regard to structural damage in the kidney and heart, we believe the observed damage is associated with the presence of autoantibodies to these organs, since both of them are rich in plakins and El Bagre-EPF patients present significant antibodies to plakin molecules.
Conclusion In patients with endemic pemphigus foliaceus, we recommend complete isolation of the patient when receiving high dosages of systemic immunosuppressive agents. We further suggest the clinical possibility of a synergistic, fatal interaction between active pemphigus foliaceus, varicella zoster virus, herpes simplex virus, immunosuppressive agents, and a systemic activation of α-1 antitrypsin. Thus, we suggest adequate bed spacing, barrier nursing, and preventative testing for α-1 antitrypsin activation are warranted in these patients to address these complications.