Bullous Pemphigoid With a Dual Pattern of XXXX .

@entity1 @entity32 @entity8 @entity500 @entity19 @entity229 @entity7248 @entity272 @entity1985 @entity72241
UNASSIGNED: A 75-year-old @entity1 presented with a blistering @entity272 and @entity1985 . Bullous pemphigoid was diagnosed by linear immunoglobulin G (IgG) and C3 staining along the basement membrane zone of a skin biopsy specimen and by the presence of circulating IgG recognizing the 180-kDa @entity7248 antigen ( @entity72241 ; type XVII collagen). A kidney biopsy specimen showed @entity32 without crescents. Direct immunofluorescence showed strong IgG and C3 staining in a combined granular and linear pattern along the glomerular basement membrane. Electron microscopy showed subepithelial deposits. In serum, no antibodies against the Goodpasture antigen (type IV collagen) or phospholipase A2 receptor were detected. Indirect immunofluorescence studies using the patient's serum showed a strikingly linear but not granular IgG pattern along the epithelial basement membranes of monkey esophagus and kidney. Although type XVII collagen was recently identified in the glomerulus, the patient's serum did not produce a 180-kDa band on immunoblot of kidney tissue and still stained glomeruli of @entity72241 knockout @entity19 by indirect immunofluorescence. The @entity1 was treated with @entity229 and @entity500 , which resulted in complete remission of skin and kidney manifestations. Although @entity7248 has been reported previously in association with anti- @entity8 or @entity8 , this case demonstrates both elements in 1 @entity1 . This concurrence and the linear pattern on indirect immunofluorescence support the possibility of cross-reactive or parallel autoantibodies to basement membranes with a secondary membranous component.
