A case of anti-laminin 332-type mucous membrane pemphigoid with ocular symptoms successfully treated with mycophenolate mofetil and prednisolone in an elderly man

MMP. Herein, we report the case of a 73-year-old male patient with high-risk MMP and 5 anti-laminin 332 antibodies. The patient initially presented with erosions on the ocular 6 and nasopharyngeal mucosae and blisters on the trunk, arms, and legs. Immunoblotting 7 with recombinant laminin 332 proteins revealed positivity for anti-laminin α3 IgG, 8 while immunoblotting with hemidesmosome-rich fraction did not detect antibodies to 9 integrin β4, leading to a diagnosis of anti-laminin 332-type MMP. Four months after the 10 initiation of treatment with 2000 mg/day mycophenolate mofetil (MMF) and 1.0 11 mg/kg/day prednisolone, all active skin and mucosal lesions disappeared. This case 12 suggests that MMF may be more effective when combined with prednisolone, while 13 exerting fewer side effects than other immunosuppressants. Thus, MMF may be a 14 candidate therapeutic option for elderly patients with ocular symptoms.Mucous membrane pemphigoid (MMP) is a rare autoimmune blistering disease 16 affecting the mucous membranes, sometimes causing blindness or potentially life- we report an elderly non-paraneoplastic case of anti-laminin 332-type MMP that was 28 successfully treated with mycophenolate mofetil and prednisolone.A 73-year-old male presented with gradually worsening erosions of the 30 nasopharyngeal and ocular mucosae (Fig. 1a-d). Three months following development of 31 the initial symptoms, vesicles with erythema appeared on the trunk (Fig. 1e) and limbs.Histopathological examination of the abdominal skin lesion revealed a subepidermal 33 bulla with eosinophil, lymphocyte, and histiocyte infiltration (Fig. 1f). Histopathological 34 examination of a nasal septal biopsy specimen revealed granulation with extensive 35 inflammation (Fig. 1g). Direct immunofluorescence revealed linear deposition of IgG 36 and C3 in the BMZ (Fig. 1h,i). Indirect immunofluorescence using normal human skin 37 showed IgG anti-BMZ antibodies, which reacted with the dermal side of the 1M NaCl-