Bullous pemphigoid and multiple sclerosis: a report of two cases with ELISA test.

We report two patients with longstanding multiple sclerosis (MS) who developed vesicles and bullae consistent with the diagnosis of bullous pemphigoid (BP). Both patients showed linear IgG at the dermal-epidermal junction, located on the epidermal side of patients' skin previously treated with 1M NaCl. In the two cases, the ELISA test was positive for the extracellular fragment of BP 180. However, the indirect immunofluorescence test (IIF) was repeatedly negative. Therapy either with prednisone plus dapsone or prednisone alone was initiated and the disease was controlled after 23 and 15 months of therapy, in patients 1 and 2, respectively. However, the first patient had a flare-up 2 months after treatment was stopped. The association of MS and BP has been described previously in 35 cases. We compare our two cases with the 25 patients previously reported in detail in the literature. We emphasize the role of the ELISA test in establishing the diagnosis of BP.

Manifestaciones cutáneas en pacientes trasplantados: estudio de 63 pacientes / Cutaneous manifestations of post-trasplanted patients. A study of 63 cases

Introducción: Las enfermedades de la piel representan una importante causa de morbilidad en los pacientes crónicamente inmunodeprimidos, incluyendo los pacientes post-trasplantados. Pacientes y métodos: Se realizó un estudio de screening transversal evaluando la incidencia de lesiones dermatológicas en 63 pacientes trasplantados cardíacos o renales controlados en el Hospital de la Santa Creu i Sant Pau. Resultados: Se revisaron 21 pacientes con trasplante cardíaco y 42 pacientes con trasplante renal. Se diagnosticaron 95 lesiones dermatológicas de nueva aparición en 61 pacientes. En 2 pacientes no se observaron lesiones cutáneas significativas. Las más frecuentes fueron las lesiones cutáneas de carácter maligno y premaligno observadas en 31 casos (33%), seguidas de las complicaciones infecciosas en 29 casos (31%). Discusión: Los pacientes trasplantados presentan complicaciones dermatológicas con frecuencia. Éstas se han relacionado con la inmunosupresión crónica y con otros factores como la exposición a la radiación ultravioleta (UV), el tipo de piel y la edad. Las series publicadas son escasas, con variaciones en la frecuencia y el tipo de lesiones dermatológicas descritas. Los pacientes trasplantados deben tener un especial control dermatológico para detectar la presencia de lesiones sospechosas malignas, premalignas o infecciosas y que puedan ser tratadas de forma precoz

Introduction: Skin diseases represent an important cause of morbidity in chronic immunocompromised patients, including post-transplanted patients. Patients and methods: A screening transversal study was realized in Hospital de la Santa Creu i Sant Pau to evaluate the incidence of dermatological lesions in 63 heart and kidney transplanted patients. Results: We reviewed 21 heart-transplanted patients and 42 kidney transplanted patients. 95 cutaneous lesions were diagnosed in 61 patients. In 2 patients, no significant cutaneous lesions were diagnosed. Cutaneous malignant and premalignant lesions were the most frequently diagnosed, finding 31 cases (33%), followed by infectious complications in 29 cases (31%). Discussion: Transplanted patients frequently present cutaneous lesions. They have been associated with the chronic immunosuppression and other factors as ultraviolet radiation exposition, skin phototype and age. There are few series in the literature with variations in lesion frequency and type. Transplanted patients may follow and strict dermatological control in order to detect the presence of malignant, premalignant or infectious lesions and to receive an early treatment