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Paraneoplastic Pemphigus

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81. Pemphigus Herpetiformis (Treatment)

. 63 (1):e8-10. . Prado R, Brice SL, Fukuda S, Hashimoto T, Fujita M. Paraneoplastic pemphigus herpetiformis with IgG antibodies to desmoglein 3 and without mucosal lesions. Arch Dermatol . 2011 Jan. 147 (1):67-71. . Ohyama B, Nishifuji K, Chan PT, Kawaguchi A, Yamashita T, Ishii N, et al. Epitope spreading is rarely found in pemphigus vulgaris by large-scale longitudinal study using desmoglein 2-based swapped molecules. J Invest Dermatol . 2012 Apr. 132 (4):1158-68. . Verdier-Sevrain S, Joly P (...) . 17(6):10. . Schoch JJ, Boull CL, Camilleri MJ, Tollefson MM, Hook KP, Polcari IC. Transplacental Transmission of Pemphigus Herpetiformis in the Setting of Maternal Lymphoma. Pediatr Dermatol . 2015 Nov-Dec. 32 (6):e234-7. . Kubota Y, Yoshino Y, Mizoguchi M. A case of herpetiform pemphigus associated with lung cancer. J Dermatol . 1994 Aug. 21(8):609-11. . Palleschi GM, Giomi B. Herpetiformis pemphigus and lung carcinoma: a case of paraneoplastic pemphigus. Acta Derm Venereol . 2002. 82(4):304-5

2014 eMedicine.com

82. Pemphigus Foliaceus (Treatment)

pemphigus foliaceus in Colombia. J Am Acad Dermatol . 2003 Oct. 49(4):609-14. . Abreu-Velez AM, Gao W, Howard MS. Patients affected by endemic pemphigus foliaceus in Colombia, South America exhibit autoantibodies to optic nerve sheath envelope cell junctions. Dermatol Pract Concept . 2018 Jan. 8 (1):1-6. . Chorzelski TP, Hashimoto T, Amagai M, et al. Paraneoplastic pemphigus with cutaneous and serological features of pemphigus foliaceus. Br J Dermatol . 1999 Aug. 141(2):357-9. . Grando SA, Holubar K (...) of two ELISAs for the detection of antibodies to the major pemphigus antigens, desmoglein 1 and 3. Clin Exp Dermatol . 2000 May. 25(3):236-40. . Martel P, Gilbert D, Labeille B, Kanitakis J, Joly P. A case of paraneoplastic pemphigus with antidesmoglein 1 antibodies as determined by immunoblotting. Br J Dermatol . 2000 Apr. 142(4):812-3. . Narbutt J, Sysa-Jedrzejowska A, Torzecka JD. The usefulness of enzyme-linked immunosorbent assay for serodiagnosis of pemphigus vulgaris and pemphigus foliaceus

2014 eMedicine.com

83. Pemphigus Erythematosus (Treatment)

without stem cell rescue in paraneoplastic pemphigus: report of a case and review of this new therapy for severe autoimmune disease. J Am Acad Dermatol . 1999 May. 40(5 Pt 1):750-4. . Glied M, Rico MJ. Treatment of autoimmune blistering diseases. Dermatol Clin . 1999 Apr. 17(2):431-40, x. . Tan BB, Lear JT, Gawkrodger DJ, English JS. Azathioprine in dermatology: a survey of current practice in the U.K. Br J Dermatol . 1997 Mar. 136(3):351-5. . [Guideline] Anstey AV, Wakelin S, Reynolds NJ. Guidelines (...) Dermatol Ges . 2017 Dec. 15 (12):1211-1226. . Ozog DM, Gogstetter DS, Scott G, Gaspari AA. Minocycline-induced hyperpigmentation in patients with pemphigus and pemphigoid. Arch Dermatol . 2000 Sep. 136(9):1133-8. . Borradori L, Lombardi T, Samson J, Girardet C, Saurat JH, Hugli A. Anti-CD20 monoclonal antibody (rituximab) for refractory erosive stomatitis secondary to CD20(+) follicular lymphoma-associated paraneoplastic pemphigus. Arch Dermatol . 2001 Mar. 137(3):269-72. . Goebeler M, Herzog S

2014 eMedicine.com

84. Pemphigus, IgA (Overview)

, Patterson JW. Immunoglobulin A pemphigus involving the perianal skin and oral mucosa: an unusual presentation. Cutis . 2007 Sep. 80(3):218-20. . Neethu KC, Rao R, Balachandran C, Pai S. Juvenile IgA pemphigus: A case report and review of literature. Indian J Dermatol Venereol Leprol . 2016 Jul-Aug. 82 (4):439-42. . Porro AM, Caetano Lde V, Maehara Lde S, Enokihara MM. Non-classical forms of pemphigus: pemphigus herpetiformis, IgA pemphigus, paraneoplastic pemphigus and IgG/IgA pemphigus. An Bras (...) Pemphigus, IgA (Overview) IgA Pemphigus: Background, Pathophysiology, Epidemiology Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTA2Mzc3Ni1vdmVydmlldw== processing > IgA Pemphigus Updated: Apr 18, 2017 Author

2014 eMedicine.com

85. Pemphigus, IgA (Follow-up)

, Maehara Lde S, Enokihara MM. Non-classical forms of pemphigus: pemphigus herpetiformis, IgA pemphigus, paraneoplastic pemphigus and IgG/IgA pemphigus. An Bras Dermatol . 2014 Jan-Feb. 89 (1):96-106. . Howell SM, Bessinger GT, Altman CE, Belnap CM. Rapid response of IgA pemphigus of the subcorneal pustular dermatosis subtype to treatment with adalimumab and mycophenolate mofetil. J Am Acad Dermatol . 2005 Sep. 53(3):541-3. . Gruss C, Zillikens D, Hashimoto T, et al. Rapid response of IgA pemphigus (...) Pemphigus, IgA (Follow-up) IgA Pemphigus Treatment & Management: Medical Care, Activity, Complications Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTA2Mzc3Ni10cmVhdG1lbnQ= processing > IgA Pemphigus Treatment

2014 eMedicine.com

86. Pemphigus Erythematosus (Follow-up)

without stem cell rescue in paraneoplastic pemphigus: report of a case and review of this new therapy for severe autoimmune disease. J Am Acad Dermatol . 1999 May. 40(5 Pt 1):750-4. . Glied M, Rico MJ. Treatment of autoimmune blistering diseases. Dermatol Clin . 1999 Apr. 17(2):431-40, x. . Tan BB, Lear JT, Gawkrodger DJ, English JS. Azathioprine in dermatology: a survey of current practice in the U.K. Br J Dermatol . 1997 Mar. 136(3):351-5. . [Guideline] Anstey AV, Wakelin S, Reynolds NJ. Guidelines (...) Dermatol Ges . 2017 Dec. 15 (12):1211-1226. . Ozog DM, Gogstetter DS, Scott G, Gaspari AA. Minocycline-induced hyperpigmentation in patients with pemphigus and pemphigoid. Arch Dermatol . 2000 Sep. 136(9):1133-8. . Borradori L, Lombardi T, Samson J, Girardet C, Saurat JH, Hugli A. Anti-CD20 monoclonal antibody (rituximab) for refractory erosive stomatitis secondary to CD20(+) follicular lymphoma-associated paraneoplastic pemphigus. Arch Dermatol . 2001 Mar. 137(3):269-72. . Goebeler M, Herzog S

2014 eMedicine.com

87. Pemphigus Foliaceus (Follow-up)

pemphigus foliaceus in Colombia. J Am Acad Dermatol . 2003 Oct. 49(4):609-14. . Abreu-Velez AM, Gao W, Howard MS. Patients affected by endemic pemphigus foliaceus in Colombia, South America exhibit autoantibodies to optic nerve sheath envelope cell junctions. Dermatol Pract Concept . 2018 Jan. 8 (1):1-6. . Chorzelski TP, Hashimoto T, Amagai M, et al. Paraneoplastic pemphigus with cutaneous and serological features of pemphigus foliaceus. Br J Dermatol . 1999 Aug. 141(2):357-9. . Grando SA, Holubar K (...) of two ELISAs for the detection of antibodies to the major pemphigus antigens, desmoglein 1 and 3. Clin Exp Dermatol . 2000 May. 25(3):236-40. . Martel P, Gilbert D, Labeille B, Kanitakis J, Joly P. A case of paraneoplastic pemphigus with antidesmoglein 1 antibodies as determined by immunoblotting. Br J Dermatol . 2000 Apr. 142(4):812-3. . Narbutt J, Sysa-Jedrzejowska A, Torzecka JD. The usefulness of enzyme-linked immunosorbent assay for serodiagnosis of pemphigus vulgaris and pemphigus foliaceus

2014 eMedicine.com

88. Pemphigus Herpetiformis (Follow-up)

. 63 (1):e8-10. . Prado R, Brice SL, Fukuda S, Hashimoto T, Fujita M. Paraneoplastic pemphigus herpetiformis with IgG antibodies to desmoglein 3 and without mucosal lesions. Arch Dermatol . 2011 Jan. 147 (1):67-71. . Ohyama B, Nishifuji K, Chan PT, Kawaguchi A, Yamashita T, Ishii N, et al. Epitope spreading is rarely found in pemphigus vulgaris by large-scale longitudinal study using desmoglein 2-based swapped molecules. J Invest Dermatol . 2012 Apr. 132 (4):1158-68. . Verdier-Sevrain S, Joly P (...) . 17(6):10. . Schoch JJ, Boull CL, Camilleri MJ, Tollefson MM, Hook KP, Polcari IC. Transplacental Transmission of Pemphigus Herpetiformis in the Setting of Maternal Lymphoma. Pediatr Dermatol . 2015 Nov-Dec. 32 (6):e234-7. . Kubota Y, Yoshino Y, Mizoguchi M. A case of herpetiform pemphigus associated with lung cancer. J Dermatol . 1994 Aug. 21(8):609-11. . Palleschi GM, Giomi B. Herpetiformis pemphigus and lung carcinoma: a case of paraneoplastic pemphigus. Acta Derm Venereol . 2002. 82(4):304-5

2014 eMedicine.com

89. Pemphigus Vulgaris (Follow-up)

of IgA antibodies to desmogleins 1 and 3 in pemphigus vulgaris, pemphigus foliaceus and paraneoplastic pemphigus. Br J Dermatol . 2007 Apr. 156(4):635-41. . Bhol K, Mohimen A, Ahmed AR. Correlation of subclasses of IgG with disease activity in pemphigus vulgaris. Dermatology . 1994. 189 Suppl 1:85-9. . Wilson CL, Wojnarowska F, Dean D, Pasricha JS. IgG subclasses in pemphigus in Indian and UK populations. Clin Exp Dermatol . 1993 May. 18(3):226-30. . Fitzpatrick RE, Newcomer VD. The correlation (...) Pemphigus Vulgaris (Follow-up) Pemphigus Vulgaris Treatment & Management: Medical Care, Consultations, Diet Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTA2NDE4Ny10cmVhdG1lbnQ= processing > Pemphigus Vulgaris

2014 eMedicine.com

90. Pemphigus, IgA (Diagnosis)

, Patterson JW. Immunoglobulin A pemphigus involving the perianal skin and oral mucosa: an unusual presentation. Cutis . 2007 Sep. 80(3):218-20. . Neethu KC, Rao R, Balachandran C, Pai S. Juvenile IgA pemphigus: A case report and review of literature. Indian J Dermatol Venereol Leprol . 2016 Jul-Aug. 82 (4):439-42. . Porro AM, Caetano Lde V, Maehara Lde S, Enokihara MM. Non-classical forms of pemphigus: pemphigus herpetiformis, IgA pemphigus, paraneoplastic pemphigus and IgG/IgA pemphigus. An Bras (...) Pemphigus, IgA (Diagnosis) IgA Pemphigus: Background, Pathophysiology, Epidemiology Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTA2Mzc3Ni1vdmVydmlldw== processing > IgA Pemphigus Updated: Apr 18, 2017 Author

2014 eMedicine.com

91. Pemphigus Vulgaris (Diagnosis)

of the Pathogenesis of Pemphigus and Pemphigoid Meeting in Munich, September 2016. J Invest Dermatol . 2017 Jun. 137 (6):1199-1203. . Mentink LF, de Jong MC, Kloosterhuis GJ, Zuiderveen J, Jonkman MF, Pas HH. Coexistence of IgA antibodies to desmogleins 1 and 3 in pemphigus vulgaris, pemphigus foliaceus and paraneoplastic pemphigus. Br J Dermatol . 2007 Apr. 156(4):635-41. . Bhol K, Mohimen A, Ahmed AR. Correlation of subclasses of IgG with disease activity in pemphigus vulgaris. Dermatology . 1994. 189 Suppl 1 (...) Pemphigus Vulgaris (Diagnosis) Pemphigus Vulgaris: Practice Essentials, Background, Pathophysiology Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTA2NDE4Ny1vdmVydmlldw== processing > Pemphigus Vulgaris Updated

2014 eMedicine.com

92. Pemphigus Erythematosus (Diagnosis)

, Cohen JJ, Kerdel FA. Immunoablative high-dose cyclophosphamide without stem cell rescue in pemphigus foliaceus. Int J Dermatol . 2002 Jun. 41(6):340-4. . Hayag MV, Cohen JA, Kerdel FA. Immunoablative high-dose cyclophosphamide without stem cell rescue in a patient with pemphigus vulgaris. J Am Acad Dermatol . 2000 Dec. 43(6):1065-9. . Nousari HC, Brodsky RA, Jones RJ, Grever MR, Anhalt GJ. Immunoablative high-dose cyclophosphamide without stem cell rescue in paraneoplastic pemphigus: report (...) , Gogstetter DS, Scott G, Gaspari AA. Minocycline-induced hyperpigmentation in patients with pemphigus and pemphigoid. Arch Dermatol . 2000 Sep. 136(9):1133-8. . Borradori L, Lombardi T, Samson J, Girardet C, Saurat JH, Hugli A. Anti-CD20 monoclonal antibody (rituximab) for refractory erosive stomatitis secondary to CD20(+) follicular lymphoma-associated paraneoplastic pemphigus. Arch Dermatol . 2001 Mar. 137(3):269-72. . Goebeler M, Herzog S, Brocker EB, Zillikens D. Rapid response of treatment-resistant

2014 eMedicine.com

93. Pemphigus Foliaceus (Diagnosis)

), endemic pemphigus foliaceus, endemic pemphigus foliaceus with antigenic reactivity characteristic of paraneoplastic pemphigus (but with no neoplasm), immunoglobulin A (IgA) pemphigus foliaceus, and drug-induced pemphigus foliaceus. See ; ; ; and for more information. Senear and Usher originally described PE in 1926 as an unusual type of pemphigus with features of lupus erythematosus. PE (also known as Senear-Usher syndrome) is best viewed as a localized form of pemphigus foliaceus. Chorzelski et al (...) but occurs in an endemic fashion. [ , ] It also may have autoantibodies to optic nerve sheath envelope cell junctions, the clinical significance of which is unknown. [ ] Heterogeneous antigenic reactivity was observed as in paraneoplastic pemphigus but with no evidence of association with neoplasia. This endemic pemphigus disease in El Bagre had immunologic features similar to pemphigus foliaceus or erythematosus. Chorzelski et al in 1999 [ ] described paraneoplastic pemphigus with cutaneous

2014 eMedicine.com

94. Pemphigus Herpetiformis (Diagnosis)

-negative pemphigus herpetiformis. J Am Acad Dermatol . 2010 Jul. 63 (1):e8-10. . Prado R, Brice SL, Fukuda S, Hashimoto T, Fujita M. Paraneoplastic pemphigus herpetiformis with IgG antibodies to desmoglein 3 and without mucosal lesions. Arch Dermatol . 2011 Jan. 147 (1):67-71. . Ohyama B, Nishifuji K, Chan PT, Kawaguchi A, Yamashita T, Ishii N, et al. Epitope spreading is rarely found in pemphigus vulgaris by large-scale longitudinal study using desmoglein 2-based swapped molecules. J Invest Dermatol (...) of onset at 6 years. Dermatol Online J . 2011 Jun 15. 17(6):10. . Schoch JJ, Boull CL, Camilleri MJ, Tollefson MM, Hook KP, Polcari IC. Transplacental Transmission of Pemphigus Herpetiformis in the Setting of Maternal Lymphoma. Pediatr Dermatol . 2015 Nov-Dec. 32 (6):e234-7. . Kubota Y, Yoshino Y, Mizoguchi M. A case of herpetiform pemphigus associated with lung cancer. J Dermatol . 1994 Aug. 21(8):609-11. . Palleschi GM, Giomi B. Herpetiformis pemphigus and lung carcinoma: a case of paraneoplastic

2014 eMedicine.com

95. Analysis of the reactivity of indirect immunofluorescence in patients with pemphigus foliaceus and pemphigus vulgaris using rat bladder epithelium as a substrate (PubMed)

foliaceus (44%) had positive indirect immunofluorescence using rat bladder epithelium as a substrate.Indirect immunofluorescence using rat bladder epithelium as a substrate is recommended whenever a diagnosis of paraneoplastic pemphigus is considered. The identification of a subset of pemphigus foliaceus and pemphigus vulgaris patients that recognizes desmoplakins by this laboratory tool is critical to avoid the misdiagnosis of paraneoplastic pemphigus. (...) Analysis of the reactivity of indirect immunofluorescence in patients with pemphigus foliaceus and pemphigus vulgaris using rat bladder epithelium as a substrate To evaluate the reactivity of indirect immunofluorescence using rat bladder epithelium as a substrate in patients with pemphigus foliaceus and pemphigus vulgaris from the Department of Dermatology, University of São Paulo Medical School, Brazil.Thirty-two patients (8 male and 24 female) from the Department of Dermatology, University

Full Text available with Trip Pro

2011 Clinics

96. Efficacy and Safety of Ofatumumab in Treatment of Pemphigus Vulgaris

methods are not applicable in Japan: oral contraceptives with progestogen alone, injectable progesterone, levonorgestrel implants, estrogenic vaginal ring, percutaneous contraceptive patches, vaginal spermicidal foam, gel, film, and cream French subjects: In France, a subject will be eligible for inclusion in this study only if either affiliated to or a beneficiary of a social security category. Exclusion Criteria: Diagnosis of pemphigus foliaceus, paraneoplastic pemphigus, or other autoimmune (...) Efficacy and Safety of Ofatumumab in Treatment of Pemphigus Vulgaris Efficacy and Safety of Ofatumumab in Treatment of Pemphigus Vulgaris - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Efficacy and Safety

2013 Clinical Trials

97. Epitope Spreading Is Rarely Found in Pemphigus Vulgaris by Large-Scale Longitudinal Study Using Desmoglein 2-Based Swapped Molecules. (PubMed)

and anti-Dsg3/Dsg1 mucocutaneous-type PV. These N-terminal epitopes were calcium dependent. Circulating antibodies in paraneoplastic pemphigus and pemphigus herpetiformis had unique epitope distributions, although the Dsg N-termini still contained the major epitopes. These results suggest that, after onset, intramolecular and intermolecular epitope spreading among extracellular domains on Dsg3 and Dsg1 is rare in PV and has no correlation with disease course. (...) Epitope Spreading Is Rarely Found in Pemphigus Vulgaris by Large-Scale Longitudinal Study Using Desmoglein 2-Based Swapped Molecules. Epitope spreading is involved in inducing and maintaining self-reactivity. Epitope spreading in pemphigus vulgaris (PV), caused by IgG autoantibodies to desmoglein 3 (Dsg3) and Dsg1, was previously analyzed using Dsg3/Dsg1 extracellular domain-swapped molecules. However, precise identification of the responsible epitopes in each molecule by using only this method

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2012 Journal of Investigative Dermatology

98. Castleman disease and paraneoplastic pemphigus (PubMed)

Castleman disease and paraneoplastic pemphigus 19884299 2010 03 15 2018 11 13 1488-2329 182 1 2010 Jan 12 CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne CMAJ Clinical images: Castleman disease and paraneoplastic pemphigus. 61 10.1503/cmaj.081504 Kop Else N EN Department of Dermatology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands. MacKenzie Marius A MA eng Case Reports Journal Article 2009 11 02 Canada CMAJ 9711805 0820-3946 AIM (...) IM Adult Castleman Disease complications diagnostic imaging Female Humans Mediastinal Neoplasms diagnostic imaging Paraneoplastic Syndromes etiology pathology Pemphigus etiology pathology Radiography 2009 11 4 6 0 2009 11 4 6 0 2010 3 17 6 0 ppublish 19884299 cmaj.081504 10.1503/cmaj.081504 PMC2802608 Cancer. 1972 Mar;29(3):670-83 4551306 N Engl J Med. 2003 Jul 24;349(4):382-91 12878746

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2010 CMAJ : Canadian Medical Association Journal

99. Serum plakophilin-3 autoreactivity in paraneoplastic pemphigus. (PubMed)

Serum plakophilin-3 autoreactivity in paraneoplastic pemphigus. Paraneoplastic pemphigus (PNP) is a malignancy-associated autoimmune disease in which circulating autoantibodies recognize various polypeptides that constitute the desmosomes and hemidesmosomes of epithelial structures.To determine whether PNP is associated with autoreactivity against the armadillo-repeat-containing plakophilin-3 (PKP3) protein.HEK293 cells were transiently transfected with either a pEF6/myc-His or a pEGFP-N2 (...) construct, both encoding human PKP3 (protein products of 85 kDa and 115 kDa, respectively). Protein lysates were made in Laemmli buffer. The proteins were separated by gel electrophoresis, transferred to filters and probed with five PNP sera, four pemphigus vulgaris sera, two pemphigus foliaceus sera, five bullous pemphigoid sera, one cicatricial pemphigoid serum and one linear IgA dermatosis serum. A mouse monoclonal anti-PKP3 antibody raised against a 20-amino acid peptide of human PKP3 was used

2010 British Journal of Dermatology

100. The Etiology of Paraneoplastic Autoimmunity. (PubMed)

recognized in the setting of paraneoplastic autoimmunity can be diverse, and the number of determinants recognized within a single antigen can be numerous. This review uses prototypic examples of paraneoplastic immune-mediated diseases and their associated malignancies to describe the mechanisms by which immune dysregulation can occur in the setting of cancer. Specific diseases covered include paraneoplastic pemphigus, Sweet's syndrome, pyoderma gangrenosum, thymoma-associated multiorgan autoimmunity (...) The Etiology of Paraneoplastic Autoimmunity. Although they may sometimes appear similar, paraneoplastic autoimmunity has a unique pathogenesis, different from the classical autoimmune diseases not associated with cancer. When distinguished clinically, paraneoplastic autoimmunity is more severe and often presents with a broader range of clinical signs and symptoms. Management of these patients is difficult and is usually centered in part on treatment of the underlying malignancy. Self-antigens

2011 Clinical Reviews in Allergy & Immunology

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