A 70-year-old man develops tense bullae and erosions exclusively on oral mucosa, conjunctiva, and nasopharynx. Skin is spared. DIF shows linear IgG and C3 at BMZ. Anti-laminin-332 antibodies are detected. Which systemic complication requires urgent investigation?
- A Renal impairment
- B Pulmonary fibrosis
- C Peripheral neuropathy
- D Occult malignancy (especially adenocarcinoma) ✓
Explanation
Mucous membrane pemphigoid (MMP) targeting laminin-332 (epiligrin-type MMP) is strongly associated with underlying internal malignancy, particularly adenocarcinomas (gastric, breast, lung, and colorectal). Anti-laminin-332 antibodies in MMP carry approximately a 25–30% risk of occult malignancy. This is in contrast to anti-BP180 or anti-BP230 MMP which has no such strong malignancy association. Urgent malignancy screening including CT thorax-abdomen-pelvis and endoscopy is mandatory. Cicatricial changes (scarring) in conjunctiva can cause blindness and airway stenosis are ocular/mucosal concerns.
Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.