Dermatológia pre prax 3/2011

IgA pemphigus and monoclonal gammopathy, is there a connection ?

Monoclonal gammopathy-associated IgA pemphigus is a debilitating skin disorder with inconsistent response to treatment. A 61-year old female patient with IgA pemphigus and monoclonal gammopathy of unknown significance had been treated unsuccessfully with cyclophosphamide/dexamethasone and then with rituximab. When the monoclonal gammopathy progressed to multiple myeloma, the patient received treatment with cyclophosphamide/doxorubicin/dexamethasone but there was no clinical response. Second-line therapy with thalidomide/cyclophosphamide/dexamethasone combination led to severe exacerbation of the skin disorder. However, therapy with combination regimen that included bortezomib, cyclophosphamide, and dexamethasone resulted in complete and durable remission of multiple myeloma and IgA pemphigus. This suggests that bortezomib-based therapy is useful for the treatment of the rare dermatologic disorder associated with IgA gammopathy and that monoclonal immunoglobulin of IgA class was the cause of IgA pemphigus.

Keywords: IgA pemphigus, subcorneal pustular dermatosis, bortezomib, rituximab, monoclonal gammopathy.