False‐negative direct immunofluorescence testing in vancomycin‐induced linear IgA bullous dermatosis: a diagnostic pitfall

Winn, Aubrey E.; Spillane, Erin L.; Peterson, Dave J.; Sperling, Leonard C.; Meyerle, Jon H

doi:10.1111/cup.12742

Cited by 6 publications

(8 citation statements)

References 2 publications

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“…Recent reports show that conventional diagnostic studies may not be the most accurate for drug-induced LAD. One case of vancomycin-induced LAD in a patient with renal insufficiency initially showed a negative DIF, but upon repeat biopsy, DIF result was positive [ 3 ]. This case highlights the importance of repeat DIF if clinical suspicion is high and if patients have immune dysregulation such as renal insufficiency, which can alter immunofluorescence studies.…”

Section: Resultsmentioning

confidence: 99%

“…In a 6-year-old female with partial glucose-6-phosphate dehydrogenase deficiency, topical methylprednisolone 0.1% twice daily (vehicle not specified) and clobetasol shampoo resulted in resolution within a month [20]. In an adult case of vancomycin-induced LAD, vancomycin cessation and triamcinolone 0.1% ointment alone were enough to resolve bullae [3]. It is unclear as to how long after clinical improvement the patient continued to use topical corticosteroids.…”

Section: Topical Corticosteroidsmentioning

confidence: 99%

“…In the pediatric population, it is known as chronic bullous disease of childhood (CBDC). Direct immunofluorescence (DIF) remains the gold standard for diagnosis in both adult and pediatric populations, but there have been cases of false-negative results in drug-induced LAD [ 3 , 4 ]. Management of this relatively rare disease process varies throughout the literature.…”

Section: Introductionmentioning

confidence: 99%

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Updates in the Diagnosis and Management of Linear IgA Disease: A Systematic Review

2021

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Background and Objectives: Linear IgA disease (LAD) is a rare autoimmune blistering disease with linear IgA deposits along the basement membrane zone. Direct immunofluorescence remains the gold standard for diagnosis, but other diagnostic measures reported in recent literature have proven useful in the setting of inconclusive preliminary results. Dapsone is a commonly used treatment, but many therapeutic agents have emerged in recent years. The objective of this study is to provide a comprehensive overview of updates on the diagnosis and management of LAD. Materials and Methods: A literature search was conducted from May to June of 2021 for articles published in the last 5 years that were related to the diagnosis and management of LAD. Results: False-negative results in cases of drug-induced LAD and the presence of IgG and IgM antibodies on immunofluorescence studies were reported. Serration pattern analysis has been reported to be useful in distinguishing LAD from sublamina densa-type LAD. Rituximab, omalizumab, etanercept, IVIg, sulfonamides, topical corticosteroids, and others have been used successfully in adult and pediatric patients with varying disease severity. Topical corticosteroids were preferred for pediatric patients while rituximab and IVIg were used in adults with recalcitrant LAD. Sulfonamides were utilized in places without access to dapsone. Conclusion: In cases where preliminary biopsy results are negative and clinical suspicion is high, repeat biopsy and additional diagnostic studies should be used. Patient factors such as age, medical comorbidities, and disease severity play a role in therapeutic selection.

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Section: Resultsmentioning

confidence: 99%

Section: Topical Corticosteroidsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Updates in the Diagnosis and Management of Linear IgA Disease: A Systematic Review

2021

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“…Diagnosis of LABD may be complicated and difficult to differentiate from other severe cutaneous reactions as 42% of patients have mucosal involvement, 20% have lesions mimicking TEN, and 21% have eosinophil infiltrates [49]. LABD relies on direct immunofluorescence (DIF) testing showing linear deposition of immunoglobulin IgA along the basement membrane of the epidermis, present in up to 80% of cases, for diagnosis; however, cases of LABD with an initial negative DIF followed by repeat positive testing have been noted [50]. Typically, the only cessation of vancomycin is necessary for the resolution of symptoms; adjunctive topical corticosteroids may also be initiated.…”

Section: Linear Immunoglobulin a Bullous Dermatosismentioning

confidence: 99%

Glycopeptide Hypersensitivity and Adverse Reactions

2020

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Glycopeptides, such as vancomycin and teicoplanin, are primarily used in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections, such as cellulitis, endocarditis, meningitis, pneumonia, and septicemia, and are some of the most commonly prescribed parenteral antimicrobials. Parenteral glycopeptides are first-line therapy for severe MRSA infections; however, oral vancomycin is used as a first-line treatment of Clostridioides difficile infections. Also, we currently have the longer-acting lipoglycopeptides, such as dalbavancin, oritavancin, and telavancin to our armamentarium for the treatment of MRSA infections. Lastly, vancomycin is often used as an alternative treatment for patients with β-lactam hypersensitivity. Common adverse effects associated with glycopeptide use include nephrotoxicity, ototoxicity, and Redman Syndrome (RMS). The RMS is often mistaken for a true allergy; however, it is a histamine-related infusion reaction rather than a true immunoglobulin E (IgE)-mediated allergic reaction. Although hypersensitivity to glycopeptides is rare, both immune-mediated and delayed reactions have been reported in the literature. We describe the various types of glycopeptide hypersensitivity reactions associated with glycopeptides and lipoglycopeptides, including IgE-mediated reactions, RMS, and linear immunoglobulin A bullous dermatosis, as well as describe cross-reactivity with other glycopeptides.

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“…Recently, false-negative DIF microscopy has been reported in a case of drug-induced LAD; however, a repeat biopsy revealed the presence of linear IgA band in this patient. [ 34 ] This signifies the importance of reviewing the slide, re-sectioning the biopsy, and if necessary repeating the biopsy in clinically suspected cases of AIBD where initial DIF is negative.…”

Section: Pitfalls Of Immunofluorescence Techniquementioning

confidence: 99%

Utility of immunofluorescence in dermatology

Shetty

Subramaniam

Rao

2017

Indian Dermatol Online J

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Immunofluorescence (IF) tests have redefined our understanding of many immune-mediated skin diseases, especially autoimmune blistering diseases (AIBDs). Nomenclature of certain AIBDs (for example, linear IgA diseases and IgA pemphigus) has been done based solely on the finding of tissue-bound immunoreactants as detected by IF tests. Direct and indirect are the two major types of IF tests; they are not only useful in the diagnosis but also guide the clinician in the treatment at least in certain AIBDs, as the titer of circulating antibodies as detected by IF reflects the disease activity. In this review, we describe techniques, various types of IF, and its modification.

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False‐negative direct immunofluorescence testing in vancomycin‐induced linear IgA bullous dermatosis: a diagnostic pitfall

Cited by 6 publications

References 2 publications

Updates in the Diagnosis and Management of Linear IgA Disease: A Systematic Review

Updates in the Diagnosis and Management of Linear IgA Disease: A Systematic Review

Glycopeptide Hypersensitivity and Adverse Reactions

Utility of immunofluorescence in dermatology

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