Abstract
Observation: An 82-year-old patient treated with the antihistamine ebastine (Kestin ® ) for allergic rhinitis presented for gingival pain. The diagnosis of mucous membrane pemphigoid was suspected after a positive pinch test. Blood examinations highlighted AC anti-PBGA2, and the gingival biopsy showed an epithelioconjunctival delamination and the presence of anti-IgA antibody and C3 deposition along the basal of the membrane. Topical corticosteroid administration was initiated. The symptoms improved but elevated IgA and C3 levels persisted. He underwent a complete remission on cessation of ebastine treatment. Commentary: Mucous membrane pemphigoid is an autoimmune disease whose origin remains unclear. The aim of the treatment is to decrease the symptoms, but full recovery of the patients is exceptional. We report here a clinical case with symptom resolution because of the ebastine withdrawal. Ebastine can thus be suspected as a cause if a patient presents with oral symptoms of mucous membrane pemphigoid.
Highlights
We introduce the case of an 82-year-old patient who consulted us in July 2015 for a detached gingival epithelium evolving over a year. He was receiving various treatments, including the antihistamine ebasti ne (Kestin®) for a dust-mite allergy, which was continuing over several years
Further examinations were performed: a biopsy was performed for histopathological examination and a direct immunofluorescence (IFD) examination as well as enzyme-linked immunosorbent assay (ELISA) tests, for anti-desmoglein 1 and 3 and anti BP180 and BP230
The ELISA test was positive for anti-PBGA2 antibodies
Summary
We introduce the case of an 82-year-old patient who consulted us in July 2015 for a detached gingival epithelium evolving over a year. At the endobuccal clinical examination, this patient had 3-cm long and 5-cm wide bubble lesions on the left mandibular gingivobuccal-jugular furrow in the form of a linear ulceration (Fig. 1). The pinch test was positive (Fig. 2). The patient had initially attempted treatment using antifungal agents, healing ointments, and mouthwashes without any effect. The pathology result revealed a subepithelial lymphoplasmacytic infiltrate with an epithelial–connective tissue detachment and the presence of the autoimmune antibodies; antiIgG, IgA, and C3 along the basal membrane (Fig. 3).
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