Granular C3 dermatosis‐like immunological manifestation found in a case of acute generalized exanthematous pustulosis: Implication for the mechanism in C3 deposition to the epidermal basement membrane zone

Furukawa, Hidehiko; Omura, Reina; Sugiura, Kazumitsu; Kanazawa, Nobuo; Inoue, Norimitsu; Qian, Hua; Li, Xiaoguang; Tsuruta, Daisuke; Hashimoto, Takashi

doi:10.1111/1346-8138.15853

The Journal of Dermatology

2021

DOI: 10.1111/1346-8138.15853

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Granular C3 dermatosis‐like immunological manifestation found in a case of acute generalized exanthematous pustulosis: Implication for the mechanism in C3 deposition to the epidermal basement membrane zone

Hidehiko Furukawa

Reina Omura

Kazumitsu Sugiura

et al.

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Granular C3 dermatosis—A report of two cases and a mini‐review of literature

Takayama,

Kuwahara,

Yoshioka

et al. 2024

The Journal of Dermatology

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Granular C3 dermatosis (GCD) is characterized by bullous, erythematous, and eczematous skin lesions similar to dermatitis herpetiformis, and granular deposition of complement C3 and C5b‐9 along the epidermal basement membrane zone (BMZ) by direct immunofluorescence (IF). Here, we present two cases of GCD with different clinical features. Case 1, a 49‐year‐old man, showed pruritic blisters and erythema of the extremities. Case 2, a 53‐year‐old woman, showed severely pruritic papules, erythema, and erosions on the entire body with scattered blisters, mainly on the lower extremities. Both patients showed mild eosinophilia on blood tests, subepidermal blisters and prominent eosinophilic infiltration in the upper dermis on histopathological examination, and granular BMZ deposition of C3, but not of immunoglobulins or other complement components, on direct IF. No circulating autoantibodies were detected on enzyme‐linked immunosorbent assays, chemiluminescent enzyme immunoassays, indirect IF using 1 mol/L NaCl‐split normal human skin, or immunoblotting. Diagnosis of GCD was made in both cases. Case 1 was successfully treated with topical steroids, oral minocycline, and nicotinamide without any recurrence of symptoms. Case 2 was treated with oral steroids and showed remarkable improvement, although mild pruritic papules remained. We reviewed 30 reported GCD cases, including the two cases presented here, since Hashimoto et al. first described GCD in 2016. GCD should be more widely recognized, and further accumulation and validation of cases are required.

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Granular C3 dermatosis—A report of two cases and a mini‐review of literature

Takayama,

Kuwahara,

Yoshioka

et al. 2024

The Journal of Dermatology

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Drug Triggers and Clinic of Acute Generalized Exanthematous Pustulosis (AGEP): A Literature Case Series of 297 Patients

Vallejo-Yagüe

Torre

Mohamad

et al. 2022

JCM

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Acute generalized exanthematous pustulosis (AGEP) is a rare skin reaction, commonly caused by drugs. Available evidence mostly relies on small studies or case reports. We collected published AGEP case reports and, subsequently, described the patient characteristics, suspect and concomitant drugs, time to onset, disease management, and clinical prognosis. This study included 297 AGEP patients (64.3% women) obtained from 250 published case reports or case series with individual patient data. AGEP affected patients of all ages, but the majority of patients (88.2%) were ≥25 years old. The most frequently reported suspect drugs were anti-infectives for systemic use (36.5%), particularly antibacterials for systemic use (31.0%), and especially beta-lactam antibacterials (18.3%) and macrolides (4.3%). Other frequent suspect drugs were antineoplastics (12.2%), and anti-inflammatory/anti-rheumatic products (5.2%) plus hydroxychloroquine (12.8%). Mean time to onset was 9.1 days (standard deviation SD 13.94). Some patients developed fever (64.3%) and systemic involvement (18.9%), and most patients (76.4%) received pharmacological treatment for AGEP. Seven patients died, although five of them were already critically ill prior to AGEP. In conclusion, antibiotics remain the most common suspected cause of AGEP. While case mortality rate may be up to 2.5%, disentangling the role of AGEP on the fatal outcome from the role of the preexisting health conditions remains challenging.

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Granular C3 dermatosis‐like immunological manifestation found in a case of acute generalized exanthematous pustulosis: Implication for the mechanism in C3 deposition to the epidermal basement membrane zone

Cited by 2 publications

References 5 publications

Granular C3 dermatosis—A report of two cases and a mini‐review of literature

Granular C3 dermatosis—A report of two cases and a mini‐review of literature

Drug Triggers and Clinic of Acute Generalized Exanthematous Pustulosis (AGEP): A Literature Case Series of 297 Patients

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