Pemphigus foliaceus with anti-intercellular and anti-basement membrane zone antibodies. Blocking immunofluorescence and Western immunoblotting studies.

In a patient with clinical, histologic, and routine direct immunofluorescence (IF) findings compatible with pemphigus foliaceus (PF), anti-intercellular and anti-basement membrane zone (BMZ) antibodies were found on indirect IF. Blocking IF studies using the biotin-avidin method revealed that intercellular staining of this patient's serum was significantly decreased by sera of PF patients, however, reaction of this patient's serum was not blocked by sera of PV and BP patients. Western immunoblot analysis using the SDS extracts of normal human epidermis demonstrated that this patient's serum reacted with 370-, 220-, 170-, 130- and 21-kD proteins. Another PF serum reacted with 170- and 21-kD proteins. BP sera reacted with 220-, 68-, 46 and 21-kD proteins. Considering the results of the previous reports and this study, 220- and 170-kD protein bands are specific for BP and PF, respectively, and this is the first case of PF with both anti-intercellular and anti-BMZ circulating antibodies including immunoblotting analysis.