Pemphigus vulgaris of the larynx and upper gastro-intestinal tract induced by radiotherapy

Mucosal manifestations of pemphigus vulgaris in ear, nose, and throat; before and after treatment

“…Only a few studies have been reported in this regard, most published in ENT or internal medicine journals. [4][5][6][7][8][9][10][11][12] It seems that ENT manifestations of PV might be not clear in the early course of disease Initial symptoms and clinical lesions in our patients were recorded. All of them were evaluated to detect any ENT manifestations by otoscopic and endoscopic examinations before initiation of pemphigus treatment, whether or not they had any related symptoms.…”

Exacerbation of Pemphigus Foliaceus After Electron-beam Radiation

“…This is compatible with several theories proposed previously. One theory is that radiotherapy itself changes antigenic properties and induces autoantibody production through the alteration of the antigen with unmasking (2,12). Also in the present case, electron-beam might damage the epidermis in and outside of irradiation field and induce unmasking and alteration of the antigen, resulting in establishment of potential basis for exacerbation of PF.…”

“…These hypotheses may explain the mechanism for onset and exacerbation of pemphigus. In all the previous cases of pemphigus, including our case, the eruptions started from the areas of irradiation and then spread to other areas (2)(3)(4)(5)(6)(7)(8)(9)(10)(11). Such a clinical course indicates that irradiation influences the formation of eruptions in pemphigus.…”

“…Another possible explanation is that even patients who recently developed pemphigus after irradiation may already have had circulating low-titre autoantibodies, and tissue damage from the radiotherapy may have enhanced the deposition of those antibodies, i.e. blood vessel permeability could have increased and autoantibodies could have diffused more easily (2,12). These hypotheses may explain the mechanism for onset and exacerbation of pemphigus.…”

“…In pemphigus vulgaris (PV), the main antigen is desmoglein 3 (Dsg 3), which is located on the oral mucosa and in the lower layers of the epidermis; in pemphigus foliaceus (PF), the target antigen is desmoglein 1 (Dsg 1), which is structurally located mainly in the upper epidermis (1). It is reported that pemphigus can be induced or exacerbated by radiation therapy (2)(3)(4)(5)(6)(7)(8)(9)(10)(11). However, few reports have detailed the serum autoantibody concentrations before and after irradiation (6).…”