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Successful use of mycophenolate mofetil in combination with minocycline in a woman with severe predominantly oral mucous membrane pemphigoid: a case report
Author(s) -
Salzano S,
Arduino P,
Zambruno G,
Di Zenzo G,
Baldovino S,
Roccatello D,
Conrotto D,
Carrozzo M
Publication year - 2006
Publication title -
oral diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.953
H-Index - 87
eISSN - 1601-0825
pISSN - 1354-523X
DOI - 10.1111/j.1601-0825.2006.01308_9.x
Subject(s) - medicine , mycophenolate , azathioprine , mycophenolic acid , dermatology , tacrolimus , minocycline , pemphigoid , bullous pemphigoid , sirolimus , autoantibody , gastroenterology , direct fluorescent antibody , mucous membrane , immunology , antibiotics , pathology , disease , transplantation , antigen , antibody , microbiology and biotechnology , biology
Mucous membrane pemphigoid (MMP) is a group of rare, acquired, autoimmune sub epithelial blistering diseases. Diagnosis is based on clinical presentation, evidence of sub epithelial vesicles or bullae on routine histological analysis, and direct and indirect immunofluorescence studies. We present a case of widespread chronic severe oral erosions diagnosed as MMP thanks to positive ELISA anti‐BP180 NC16A. The patient was treated with topical and systemic corticosteroids, systemic azathioprine, topical cyclosporine and tacrolimus and different types of antibiotics between 2000 and 2004 with only limited and temporary disease control and severe side effects. The patient has been treated with mycophenolate mofetil (up to 2 g per day) and systemic minocycline (up to 200 mg per day) for the past 10 months, and there have been no relapses, with the complete healing of the oral ulcerations. Different studies have confirmed the essential role of autoantibodies against BP180 in the pathogenesis of MMP. Mycophenolate mofetil specifically inhibits activated lymphocytes and it has few effects on other rapidly dividing cells. Case reports and series of its use in immunobullous diseases suggest that MMF may have a role in the management of such diseases. Currently, treatment of MMP with mycophenolate mofetil and tetracyclines has not been described in the literature.