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Pemphigoide bulleuse du nourrisson


, : Pemphigoide bulleuse du nourrisson.

La pemphigo de bulleuse (PB), dermatose bulleuse auto-immune fr quente chez le sujet g , reste une maladie rare chez l enfant. Quelques cas infantiles de survenue post-vaccinale ont t d crits. Nous rapportons un nouveau cas de PB survenu apr s une premi re vaccination chez un nourrisson. Observation Une enfant g e de trois mois pr sentait brutalement une ruption bulleuse d but palmoplantaire, associ e des l sions pseudo-urticariennes des cuisses, du thorax et de l abdomen. Cette ruption survenait 15jours apr s une premi re vaccination par Infanrix Quinta et Pr venar . L histologie et l immunofluorescence cutan es montraient un clivage dermo- pidermique associ des d p ts d IgG et de C3 le long de la basale pidermique, caract ristiques de la PB. La recherche d anticorps s riques antimembrane basale tait n gative. Un traitement par dermocortico de permettait une r mission clinique apr s cinq semaines. La poursuite du calendrier vaccinal n a pas entra n de nouvelle pouss e. La pr sentation clinique de la PB chez l enfant diff re de celle de l adulte, notamment par la pr dominance de l sions palmoplantaires chez l enfant de moins d un an et par l existence d atteintes muqueuses chez l enfant plus g . Les donn es histologiques restent cependant identiques. Le d clenchement de cette maladie par un antig ne vaccinal a t sugg r . Dans la plupart des cas cependant, la poursuite de la vaccination n entra ne pas de r cidive. De plus, cette maladie est tr s rare dans l enfance, alors que les vaccinations y sont tr s fr quentes, ce qui est en faveur d une association fortuite. La PB est un diagnostic voquer devant toute ruption bulleuse de l enfant, notamment en cas d atteinte palmoplantaire. Il s agit d une affection b nigne, r solutive sous traitement, g n ralement en moins d un an. Les donn es actuelles ne permettent pas d incriminer les vaccins dans l induction de la PB de l enfant et sugg rent qu il n y a pas de contre-indication la poursuite du calendrier vaccinal chez les enfants atteints. Bullous pemphigoid (BP) is a form of autoimmune bullous disease commonly seen in adults but rare amongst children. Only a few cases have been described in children after vaccination. This article reports a new case of BP that occurred in an infant after a first vaccination. A 3-month-old girl presented a bullous eruption 2 weeks after a first injection of Infanrix Quinta and Prevenar . The eruption began on her palms and soles. It was associated with urticaria-like lesions on her thighs, chest and abdomen. A histological skin examination and direct immunofluorescence showed dermal-epidermal cleavage and IgG and C3 deposits in the epidermal basement membrane zone, which are typical features of BP. No antibodies against basement membrane were seen. Clinical remission was observed after 5 weeks of treatment with dermal-corticosteroids. Resumption of the vaccination schedule did not induce any recurrence of the disease. The clinical presentation of BP amongst children differs from that seen in adults, notably in terms of the predominance of palmoplantar lesions in children aged less than 1 year. In addition, lesions on mucous membrane are more frequently reported amongst older children. Histological findings are similar in all age groups. The outbreak of BP due to a vaccinal antigen appears hypothetical. However, continuation of the vaccination schedule did not induce any recurrence. Moreover, it is a rare disease amongst children despite the frequency of vaccinations in this population. Childhood BP is a diagnosis that should be considered in any case of bullous eruption, in particula.

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