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Vancomycin-associated linear IgA dermatosis. A report of three cases
S Carpenter1, D Berg, N Sidhu-Malik
1Department of Medicine, Duke University Medical Center, Durham, NC 27710.
Background:
Linear IgA dermatosis is an autoantibody-mediated, subepidermal blistering disease that is rarely associated with drug exposure.
Objective:
We report the development of linear IgA dermatosis in three patients associated with the administration of vancomycin and further characterize the immunopathology.
Methods:
Direct and indirect immunofluorescence assays were performed to characterize the immunoreactants, determine the subclass of the IgA deposits, and map the site of antibody deposition.
Results:
A subepidermal blistering disease developed in all patients shortly after vancomycin was initiated, which resolved on discontinuation of the drug. Immunofluorescence studies revealed linear deposits of IgA1 only at the basement membrane zone, below the lamina lucida. Circulating IgA anti-basement membrane zone antibodies were not detected.
Conclusion:
Three patients had linear IgA dermatosis in association with the administration of vancomycin. All patients had linear deposits of IgA1 localized to the sublamina densa zone. Immunophenotypically, the disease in these patients mimics the pattern of IgA deposits seen in the majority of patients with idiopathic linear IgA dermatosis.