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o teste ELISA resultou em anti&#8208;Dsg1 2&#44;0&#160;U&#47;mL e anti&#8208;Dsg3 189&#44;1&#160;U&#47;mL &#40;MBL&#44; Japan&#44; <span class="elsevierStyleItalic">cut&#8208;off</span>&#160;20&#160;U&#47;mL para ambos&#41;&#44; enquanto sua irm&#227; apresentou valores negativos ao ELISA &#40;1&#44;6 U&#47;mL e 0&#44;7&#160;U&#47;mL&#44; respectivamente&#41; e &#224; IFI&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Ambas apresentaram dois alelos HLA de suscetibilidade para PV&#58; <span class="elsevierStyleItalic">HLA&#8208;DRB1</span>&#42;08&#58;04 e <span class="elsevierStyleItalic">HLA&#8208;DRB1</span>&#42;14&#58;01&#44; enquanto os alelos <span class="elsevierStyleItalic">HLA&#8208;DQA1</span> n&#227;o estavam associados ao PV&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Apresentavam&#44; ainda&#44; dois outros alelos <span class="elsevierStyleItalic">HLA&#8208;DQB1</span>&#42;03&#58;01 e <span class="elsevierStyleItalic">HLA&#8208;DQB1</span>&#42;05&#58;01&#44; descritos em associa&#231;&#227;o &#224; resist&#234;ncia e suscetibilidade ao PF&#44; respectivamente<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Dois anos ap&#243;s&#44; apenas uma das g&#234;meas apresentava PV&#46; Embora apresentassem perfil HLA id&#234;ntico&#44; n&#227;o haviam sido expostas a fatores ambientais semelhantes&#46; Ambas moravam em regi&#227;o prevalente para o PV&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> na regi&#227;o nordeste do estado de S&#227;o Paulo&#46; A irm&#227; afetada&#44; no entanto&#44; trabalhava em atividades rurais&#44; em granja de galinhas&#44; havia&#160;10&#160;anos&#44; enquanto sua irm&#227; g&#234;mea n&#227;o afetada informava ter trabalhado sempre na zona urbana&#46; Trabalhadores rurais est&#227;o mais expostos a pesticidas&#44; incluindo outro poss&#237;vel fator desencadeante do PV<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>picadas de insetos hemat&#243;fagos&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Ao avaliarmos o perfil HLA e os fatores ambientais no desencadeamento do PV&#44; podemos detectar&#44; com anteced&#234;ncia&#44; aqueles indiv&#237;duos com maior probabilidade de desenvolver a doen&#231;a&#44; e indagamos se&#44; quando poss&#237;vel&#44; ao modificar os fatores contribuintes&#44; poderemos evitar o surgimento do PV&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Em conclus&#227;o&#44; as intera&#231;&#245;es gen&#243;tipo&#8208;fatores ambientais precisam ser mais exploradas na patog&#234;nese dos p&#234;nfigos&#44; e este relato ilustra esse cen&#225;rio&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Suporte financeiro</span><p id="par0040" class="elsevierStylePara elsevierViewall">Esse trabalho foi parcialmente financiado pela FAPESP &#40;Funda&#231;&#227;o de Amparo &#224; Pesquisa do Estado de S&#227;o Paulo&#41; &#40;&#35;2010&#47;51729&#8208;2&#41; e FAEPA &#40;Funda&#231;&#227;o de Apoio ao Ensino&#44; Pesquisa e Assist&#234;ncia&#41;&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Contribui&#231;&#227;o dos autores</span><p id="par0045" class="elsevierStylePara elsevierViewall">Marcela Rosa de Almeida Farid&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; revis&#227;o cr&#237;tica da literatura&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Roberto Bueno&#8208;Filho&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Eduardo Ant&#244;nio Donadi&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Ana Maria Roselino&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica da literatura&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflito de interesses</span><p id="par0065" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Como citar este artigo&#58; Farid MRA&#44; Bueno&#8208;Filho R&#44; Donadi EA&#44; Roselino AM&#46; Pemphigus vulgaris with exclusive manifestation in one of monozygotic twins&#58; could environmental factors be involved&#63; An Bras Dermatol&#46; 2022&#59;97&#58;692&#8211;4&#46;</p>"
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          "pt" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;a&#41; Les&#245;es na mucosa oral&#58; eros&#245;es na l&#237;ngua recobertas por pseudomembrana esbranqui&#231;ada&#44; eros&#245;es na mucosa labial&#44; eros&#245;es e crostas no l&#225;bio inferior&#46; &#40;b&#41;&#160;Imunofluoresc&#234;ncia direta na citologia oral de Tzanck&#58; fluoresc&#234;ncia com anti&#8208;IgG no envolt&#243;rio dos ceratin&#243;citos&#46; &#40;c&#41; Histologia da mucosa oral &#40;Hematoxilina &#38; eosina&#44; 40<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>&#41;&#58; bolha suprabasal acantol&#237;tica&#46; &#40;d&#41; Les&#245;es cut&#226;neas&#58; placas eritematosas no abd&#244;men e t&#243;rax com bolhas&#44; eros&#245;es e crostas hem&#225;ticas&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Refer&#234;ncias&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Forma cl&#237;nica do p&#234;nfigo vulgar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">G&#234;nero&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Idade &#40;anos&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">IFI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Anti&#8208;Dsg1 &#40;U&#47;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Anti&#8208;Dsg3 &#40;U&#47;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Alelos&#47;hapl&#243;tipos HLA<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ruocco et al&#46; &#40;1985&#41;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> It&#225;lia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">G&#234;mea&#160;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mucocut&#226;nea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Feminino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#189;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">A</span>&#42;24&#44; <span class="elsevierStyleItalic">A</span>&#42;29&#59; <span class="elsevierStyleItalic">B</span>&#42;45&#44; B&#42;35&#59; <span class="elsevierStyleItalic">C</span>&#42;04&#44; C&#42;x&#59; <span class="elsevierStyleItalic">DRB1</span>&#42;04&#44; <span class="elsevierStyleItalic">DRB1</span>&#42;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">G&#234;mea&#160;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#227;o afetada<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#58;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Salathiel et al&#46; &#40;2016&#41;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">G&#234;mea&#160;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mucocut&#226;nea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Feminino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IgG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">120&#44;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">160&#44;82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleUnderline"><span class="elsevierStyleItalic">DRB1</span>&#42;04&#58;02</span>&#8208;<span class="elsevierStyleUnderline">D</span><span class="elsevierStyleUnderline"><span class="elsevierStyleItalic">QA1</span>&#42;03&#58;01</span>&#8208;<span class="elsevierStyleUnderline"><span class="elsevierStyleItalic">DQB1</span>&#42;03&#58;02</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Brasil&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">IgG&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Farid et al&#46; &#40;2021&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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Carta ‐ Caso clínico
Pênfigo vulgar com manifestação exclusiva em uma das gêmeas monozigóticas: fatores ambientais poderiam estar envolvidos?
Marcela Rosa de Almeida Farid, Roberto Bueno‐Filho, Eduardo Antônio Donadi, Ana Maria Roselino
Autor para correspondência
amfrosel@fmrp.usp.br

Autor para correspondência.
Departamento de Clínica Médica, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, SP, Brasil
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          "pt" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;a&#41; Les&#245;es na mucosa oral&#58; eros&#245;es na l&#237;ngua recobertas por pseudomembrana esbranqui&#231;ada&#44; eros&#245;es na mucosa labial&#44; eros&#245;es e crostas no l&#225;bio inferior&#46; &#40;b&#41;&#160;Imunofluoresc&#234;ncia direta na citologia oral de Tzanck&#58; fluoresc&#234;ncia com anti&#8208;IgG no envolt&#243;rio dos ceratin&#243;citos&#46; &#40;c&#41; Histologia da mucosa oral &#40;Hematoxilina &#38; eosina&#44; 40<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>&#41;&#58; bolha suprabasal acantol&#237;tica&#46; &#40;d&#41; Les&#245;es cut&#226;neas&#58; placas eritematosas no abd&#244;men e t&#243;rax com bolhas&#44; eros&#245;es e crostas hem&#225;ticas&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">O p&#234;nfigo vulgar &#40;PV&#41; afeta principalmente as mucosas&#44; pela produ&#231;&#227;o de autoanticorpos contra Desmogleina &#40;Dsg&#41;&#160;3&#46; Na forma mucocut&#226;nea&#44; autoanticorpos anti&#8208;Dsg1 e anti&#8208;Dsg3 s&#227;o produzidos&#46; Na regi&#227;o nordeste do estado de S&#227;o Paulo<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>regi&#227;o end&#234;mica para o p&#234;nfigo foli&#225;ceo &#40;PF&#41; &#8211;&#44; a incid&#234;ncia de PV vem aumentando&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Alelos HLA de suscetibilidade&#47;prote&#231;&#227;o para o PV&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> atividades agr&#237;colas e&#44; mais recentemente&#44; prote&#237;nas salivares de picadas de insetos<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> s&#227;o descritos em associa&#231;&#227;o ao PV&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Relatos de g&#234;meos monozig&#243;ticos afetados por PV s&#227;o raros<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4&#44;5</span></a> &#40;tabela&#160;1&#41;&#46; Apresentamos o terceiro relato de irm&#227;s monozig&#243;ticas&#44; de&#160;43&#160;anos&#44; em que somente uma delas desenvolveu PV&#46; Em setembro de&#160;2018&#44; a g&#234;mea com PV apresentava m&#250;ltiplas eros&#245;es orais &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>a&#41;&#46; A imunofluoresc&#234;ncia direta &#40;IFD&#41; no esfrega&#231;o de Tzanck mostrou fluoresc&#234;ncia com anti&#8208;IgG no envolt&#243;rio dos ceratin&#243;citos &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>b&#41;&#59; a bi&#243;psia da mucosa oral confirmou bolha suprabasal acantol&#237;tica &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>c&#41;&#46; Ainda&#44; ceratin&#243;citos multinucleados sugestivos de infec&#231;&#227;o por HSV foram observados no esfrega&#231;o de Tzanck&#46; A IFD na bi&#243;psia e a imunofluoresc&#234;ncia indireta &#40;IFI&#41; com substrato de pele normal confirmaram fluoresc&#234;ncia com anti&#8208;IgG no envolt&#243;rio dos ceratin&#243;citos&#46; Foram prescritos prednisona 40<span class="elsevierStyleHsp" style=""></span>mg&#47;dia&#44; dapsona 50<span class="elsevierStyleHsp" style=""></span>mg&#47;dia e &#225;cido f&#243;lico 5<span class="elsevierStyleHsp" style=""></span>mg&#47;dia&#46; Ap&#243;s alguns dias&#44; surgiram les&#245;es no abdome&#44; t&#243;rax anterior e dorso &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>d&#41;&#44; com presen&#231;a do sinal de Nikolsky&#46; A bi&#243;psia da les&#227;o do dorso resultou bolha suprabasal acantol&#237;tica ao histopatol&#243;gico&#44; e fluoresc&#234;ncia interceratin&#243;citos para IgG e C3 &#224; IFD&#46; Ap&#243;s oito meses de tratamento&#44; a dapsona foi substitu&#237;da por ciclofosfamida&#160;50&#160;mg&#47;dia&#46; Em mar&#231;o de&#160;2020&#44; a paciente suspendeu os medicamentos em virtude da pandemia por coronav&#237;rus&#46; Em junho de&#160;2020&#44; as les&#245;es orais recidivaram&#44; quando a prednisona foi reiniciada&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Quando a paciente apresentava les&#245;es mucosas exclusivas&#44; o teste ELISA resultou em anti&#8208;Dsg1 2&#44;0&#160;U&#47;mL e anti&#8208;Dsg3 189&#44;1&#160;U&#47;mL &#40;MBL&#44; Japan&#44; <span class="elsevierStyleItalic">cut&#8208;off</span>&#160;20&#160;U&#47;mL para ambos&#41;&#44; enquanto sua irm&#227; apresentou valores negativos ao ELISA &#40;1&#44;6 U&#47;mL e 0&#44;7&#160;U&#47;mL&#44; respectivamente&#41; e &#224; IFI&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Ambas apresentaram dois alelos HLA de suscetibilidade para PV&#58; <span class="elsevierStyleItalic">HLA&#8208;DRB1</span>&#42;08&#58;04 e <span class="elsevierStyleItalic">HLA&#8208;DRB1</span>&#42;14&#58;01&#44; enquanto os alelos <span class="elsevierStyleItalic">HLA&#8208;DQA1</span> n&#227;o estavam associados ao PV&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Apresentavam&#44; ainda&#44; dois outros alelos <span class="elsevierStyleItalic">HLA&#8208;DQB1</span>&#42;03&#58;01 e <span class="elsevierStyleItalic">HLA&#8208;DQB1</span>&#42;05&#58;01&#44; descritos em associa&#231;&#227;o &#224; resist&#234;ncia e suscetibilidade ao PF&#44; respectivamente<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Dois anos ap&#243;s&#44; apenas uma das g&#234;meas apresentava PV&#46; Embora apresentassem perfil HLA id&#234;ntico&#44; n&#227;o haviam sido expostas a fatores ambientais semelhantes&#46; Ambas moravam em regi&#227;o prevalente para o PV&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> na regi&#227;o nordeste do estado de S&#227;o Paulo&#46; A irm&#227; afetada&#44; no entanto&#44; trabalhava em atividades rurais&#44; em granja de galinhas&#44; havia&#160;10&#160;anos&#44; enquanto sua irm&#227; g&#234;mea n&#227;o afetada informava ter trabalhado sempre na zona urbana&#46; Trabalhadores rurais est&#227;o mais expostos a pesticidas&#44; incluindo outro poss&#237;vel fator desencadeante do PV<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>picadas de insetos hemat&#243;fagos&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Ao avaliarmos o perfil HLA e os fatores ambientais no desencadeamento do PV&#44; podemos detectar&#44; com anteced&#234;ncia&#44; aqueles indiv&#237;duos com maior probabilidade de desenvolver a doen&#231;a&#44; e indagamos se&#44; quando poss&#237;vel&#44; ao modificar os fatores contribuintes&#44; poderemos evitar o surgimento do PV&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Em conclus&#227;o&#44; as intera&#231;&#245;es gen&#243;tipo&#8208;fatores ambientais precisam ser mais exploradas na patog&#234;nese dos p&#234;nfigos&#44; e este relato ilustra esse cen&#225;rio&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Suporte financeiro</span><p id="par0040" class="elsevierStylePara elsevierViewall">Esse trabalho foi parcialmente financiado pela FAPESP &#40;Funda&#231;&#227;o de Amparo &#224; Pesquisa do Estado de S&#227;o Paulo&#41; &#40;&#35;2010&#47;51729&#8208;2&#41; e FAEPA &#40;Funda&#231;&#227;o de Apoio ao Ensino&#44; Pesquisa e Assist&#234;ncia&#41;&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Contribui&#231;&#227;o dos autores</span><p id="par0045" class="elsevierStylePara elsevierViewall">Marcela Rosa de Almeida Farid&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; revis&#227;o cr&#237;tica da literatura&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Roberto Bueno&#8208;Filho&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Eduardo Ant&#244;nio Donadi&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Ana Maria Roselino&#58; Aprova&#231;&#227;o da vers&#227;o final do manuscrito&#59; concep&#231;&#227;o e planejamento do estudo&#59; elabora&#231;&#227;o e reda&#231;&#227;o do manuscrito&#59; obten&#231;&#227;o&#44; an&#225;lise e interpreta&#231;&#227;o dos dados&#59; participa&#231;&#227;o efetiva na orienta&#231;&#227;o da pesquisa&#59; participa&#231;&#227;o intelectual em conduta proped&#234;utica e&#47;ou terap&#234;utica de casos estudados&#59; revis&#227;o cr&#237;tica da literatura&#59; revis&#227;o cr&#237;tica do manuscrito&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflito de interesses</span><p id="par0065" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Como citar este artigo&#58; Farid MRA&#44; Bueno&#8208;Filho R&#44; Donadi EA&#44; Roselino AM&#46; Pemphigus vulgaris with exclusive manifestation in one of monozygotic twins&#58; could environmental factors be involved&#63; An Bras Dermatol&#46; 2022&#59;97&#58;692&#8211;4&#46;</p>"
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          "pt" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;a&#41; Les&#245;es na mucosa oral&#58; eros&#245;es na l&#237;ngua recobertas por pseudomembrana esbranqui&#231;ada&#44; eros&#245;es na mucosa labial&#44; eros&#245;es e crostas no l&#225;bio inferior&#46; &#40;b&#41;&#160;Imunofluoresc&#234;ncia direta na citologia oral de Tzanck&#58; fluoresc&#234;ncia com anti&#8208;IgG no envolt&#243;rio dos ceratin&#243;citos&#46; &#40;c&#41; Histologia da mucosa oral &#40;Hematoxilina &#38; eosina&#44; 40<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>&#41;&#58; bolha suprabasal acantol&#237;tica&#46; &#40;d&#41; Les&#245;es cut&#226;neas&#58; placas eritematosas no abd&#244;men e t&#243;rax com bolhas&#44; eros&#245;es e crostas hem&#225;ticas&#46;</p>"
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Refer&#234;ncias&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Forma cl&#237;nica do p&#234;nfigo vulgar&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">G&#234;nero&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Idade &#40;anos&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">IFI&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Anti&#8208;Dsg1 &#40;U&#47;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Anti&#8208;Dsg3 &#40;U&#47;mL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Alelos&#47;hapl&#243;tipos HLA<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Ruocco et al&#46; &#40;1985&#41;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> It&#225;lia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">G&#234;mea&#160;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Mucocut&#226;nea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Feminino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#189;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#58;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">A</span>&#42;24&#44; <span class="elsevierStyleItalic">A</span>&#42;29&#59; <span class="elsevierStyleItalic">B</span>&#42;45&#44; B&#42;35&#59; <span class="elsevierStyleItalic">C</span>&#42;04&#44; C&#42;x&#59; <span class="elsevierStyleItalic">DRB1</span>&#42;04&#44; <span class="elsevierStyleItalic">DRB1</span>&#42;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">G&#234;mea&#160;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">N&#227;o afetada<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#58;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ND&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Salathiel et al&#46; &#40;2016&#41;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">G&#234;mea&#160;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mucocut&#226;nea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Feminino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">IgG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">120&#44;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">160&#44;82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleUnderline"><span class="elsevierStyleItalic">DRB1</span>&#42;04&#58;02</span>&#8208;<span class="elsevierStyleUnderline">D</span><span class="elsevierStyleUnderline"><span class="elsevierStyleItalic">QA1</span>&#42;03&#58;01</span>&#8208;<span class="elsevierStyleUnderline"><span class="elsevierStyleItalic">DQB1</span>&#42;03&#58;02</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Brasil&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">G&#234;mea&#160;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IgG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74&#44;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">151&#44;66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleUnderline"><span class="elsevierStyleItalic">DRB1</span>&#42;14&#58;04</span>&#8208;<span class="elsevierStyleUnderline"><span class="elsevierStyleItalic">DQA1</span>&#42;01&#58;01</span>&#8208;<span class="elsevierStyleUnderline"><span class="elsevierStyleItalic">DQB1</span>&#42;05&#58;03</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Farid et al&#46; &#40;2021&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">G&#234;mea&#160;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mucocut&#226;nea&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Feminino&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IgG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">189&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleUnderline"><span class="elsevierStyleItalic">DRB1</span>&#42;08&#58;04</span>&#44; <span class="elsevierStyleUnderline"><span class="elsevierStyleItalic">DRB1</span>&#42;14&#58;01</span>&#59; <span class="elsevierStyleItalic">DQA1</span>&#42;01&#58;01&#44; <span class="elsevierStyleItalic">DQA1</span>&#42;05&#58;01&#59; <span class="elsevierStyleItalic">DQB1</span>&#42;03&#58;01<span class="elsevierStyleSup">&#43;</span>&#44; <span class="elsevierStyleItalic">DQB1</span>&#42;05&#58;01<span class="elsevierStyleSup">&#43;&#43;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Brasil &#40;atual&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">G&#234;mea&#160;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#227;o afetada<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IgG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Aos&#160;23&#160;anos de idade&#46;</p>"
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Aos&#160;45&#160;anos de idade&#59;<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>t&#237;tulo de anti&#8208;Dsg1 quando a paciente apresentou les&#245;es orais exclusivas&#46;</p>"
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Alelos de susceptibilidade ao PV est&#227;o sublinhados&#59; alelos de resist&#234;ncia<span class="elsevierStyleSup">&#43;</span> e suscetibilidade<span class="elsevierStyleSup">&#43;&#43;</span> ao p&#234;nfigo foli&#225;ceo &#40;ver Ref&#46; 2&#41;&#46;</p>"
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                      "titulo" => "Geographical foci and epidemiological changes of pemphigus vulgaris in four decades in Southeastern Brazil"
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                          "etal" => false
                          "autores" => array:5 [
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                        "volumen" => "56"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "class I and class II associations in pemphigus foliaceus and pemphigus vulgaris patients from a prevalent Southeastern Brazilian region"
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                          "autores" => array:7 [
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                            3 => "N&#46;H&#46;S&#46; Deghaide"
                            4 => "E&#46;A&#46; Donadi"
                            5 => "A&#46;M&#46; Roselino"
                            6 => "H&#46;L&#46;A&#46; Differential"
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                    0 => array:2 [
                      "doi" => "10.1016/j.jaut.2016.04.007"
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                        "tituloSerie" => "J Autoimmun&#46;"
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                        "volumen" => "72"
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                        "link" => array:1 [
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                      "titulo" => "Image Gallery&#58; A case of pemphigus vulgaris following Simulium spp"
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                            3 => "A&#46;G&#46; Ara&#250;jo"
                            4 => "S&#46;P&#46;F&#46; Wambier"
                            5 => "M&#46;A&#46; Cappel"
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                      "titulo" => "Pemphigus vulgaris in only one of two monozygotic twins"
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Informação do artigo
ISSN: 26662752
Idioma original: Português
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Anais Brasileiros de Dermatologia (Portuguese)
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