A Case of Autoimmune Bullous Dermatosis with Features of Pemphigus Vulgaris and Bullous Pemphigoid

BACKGROUND Pemphigus vulgaris (PV) and bullous pemphigoid (BP) are two rare but severe inflammatory dermatoses. Due to the regional lack of trained dermatologists, many patients with these two diseases are misdiagnosed and therefore incorrectly treated. An artificial intelligence diagnosis framework would be highly adaptable for the early diagnosis of these two diseases. OBJECTIVE Design and evaluate an artificial intelligence diagnosis framework for PV and BP. METHODS The work was conducted on a dermatological dataset consisting of 17,735 clinical images and 346 patient metadata of bullous dermatoses. A two-stage diagnosis framework was designed, where the first stage trained a clinical image classification model to classify bullous dermatoses from five common skin diseases and normal skin and the second stage developed a multimodal classification model of clinical images and patient metadata to further differentiate PV and BP. RESULTS The clinical image classification model and the multimodal classification model achieved an area under the receiver operating characteristic curve (AUROC) of 0.998 and 0.942, respectively. On the independent test set of 20 PV and 20 BP cases, our multimodal classification model (sensitivity: 0.85, specificity: 0.95) performed better than the average of 27 junior dermatologists (sensitivity: 0.68, specificity: 0.78) and comparable to the average of 69 senior dermatologists (sensitivity: 0.80, specificity: 0.87). CONCLUSIONS Our diagnosis framework based on clinical images and patient metadata achieved expert-level identification of PV and BP, and is potential to be an effective tool for dermatologists in remote areas in the early diagnosis of these two diseases.

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Nursing diagnoses in patients with immune-bullous dermatosis

Revista Latino-Americana de Enfermagem ◽

10.1590/1518-8345.0424.2766 ◽

2016 ◽

Vol 24 (0) ◽

Cited By ~ 2

Author(s):

Euzeli da Silva Brandão ◽

Iraci dos Santos ◽

Regina Serrão Lanzillotti ◽

Adriano Menis Ferreira ◽

Mônica Antar Gamba ◽

...

Keyword(s):

Pemphigus Vulgaris ◽

Mato Grosso ◽

Assessment Protocol ◽

Descriptive Research ◽

The North ◽

Nursing Diagnosis ◽

Bullous Dermatosis ◽

Study Participants ◽

Nursing Diagnoses ◽

Mato Grosso Do Sul

ABSTRACT Objective: identify nursing diagnoses in patients with immune-bullous dermatosis. Method: a quantitative and descriptive research, carried out in three institutions located in Rio de Janeiro and Mato Grosso do Sul, Brazil, using the Client Assessment Protocol in Dermatology during a nursing consultation. Simple descriptive statistics was used for data analysis. Results: 14 subjects participated in the study, nine with a diagnosis of pemphigus vulgaris, pemphigus two and three of bullous pemphigoid. The age ranged between 27 and 82 years, predominantly females (11). 14 nursing diagnoses were discussed and identified from a clinical rationale in all study participants, representing the most common human responses in this sample. The application of the Assessment Protocol in Dermatology facilitated the comprehensive assessment, in addition to providing the identification of diagnostics according to the North American Nursing Diagnosis Association International. Conclusion: the nursing diagnoses presented confirm the necessity of interdisciplinary work during the care for this clientele. For better description of the phenomena related to the client in question, it is suggested the inclusion of two risk factors related in three diagnoses of this taxonomy. It is worth noting the contribution of the findings for the care, education and research in nursing in dermatology.

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Present Tense: A Peculiar Case of Pemphigus Vulgaris Presenting with Tense Blisters during the COVID-19 Pandemic

Acta Medica Philippina ◽

10.47895/amp.v55i5.2890 ◽

2021 ◽

Vol 55 (5) ◽

Author(s):

Dianne Katherine R. Salazar-Paras ◽

Mae N. Ramirez-Quizon

Keyword(s):

Pemphigus Vulgaris ◽

Direct Immunofluorescence ◽

Bullous Dermatosis ◽

Present Tense ◽

Peculiar Case

Pemphigus vulgaris is an autoimmune bullous dermatosis presenting with flaccid blisters and erosions. The morphology of pemphigus reflects the more superficial intraepidermal level of split seen histologically in contrast with pemphigoid, where the level of split is deep below the epidermis. This is a case of a 58-year-old male clinically presenting with arcuate tense bullae, which are more characteristic of the pemphigoid group of disorders, which revealed an intraepidermal split and tombstoning pattern of the basal epidermis on histopathology. Direct immunofluorescence revealed intercellular IgG and C3 distribution. Although this patient presented clinically with tense bullae, the histopathology and direct immunofluorescence results were consistent with pemphigus vulgaris.

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