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August 5, 1992

Perplexing Parlance of Paraneoplastic Pemphigus-Reply

Author Affiliations

Stanford (Calif) School of Medicine
The Johns Hopkins University School of Medicine Baltimore, Md

JAMA. 1992;268(5):602-603. doi:10.1001/jama.1992.03490050050016

In Reply.  —Our original report1 examined the autoantibodies of five affected patients and we reported that all sera contained polyclonal autoantibodies with IgG subclass 1 predominating. We are pleased to see that the report by Liu et al2 confirms this. We appreciate the comments by Helm et al in the above letter. One of the points of our case report was that an "active" or "detectable" malignancy evidently is not necessary for the induction of paraneoplastic pemphigus, a syndrome of unknown cause that is clearly distinct from pemphigus vulgaris associated with neoplasia. Our patient did have a large-cell lymphoma that was in remission and "undetectable" by repeated computed tomographic scans and at autopsy. Therefore, the paraneoplastic pemphigus occurred in a patient who had a serious malignancy in remission. We would not say that there is an established "causal relationship" between the malignancy and bullous eruption. The experience to