Current concepts of immunofluorescence in oral mucocutaneous diseases

Abstract

Aim: To study the immunofluorescence pattern and to assess its reliability as a confirmatory diagnostic test in patients with pemphigus, pemphigoid, lichen planus, and lupus erythematosus and also to assess the disease activity by indirect immunofluorscence (IIF) in patients with pemphigus only.

Materials and methods: Twenty-six patients were included in the study group, out of which, 6 patients were clinically and histopathologically diagnosed as pemphigus, completely free of active lesions were subjected to IIF only to assess the disease activity and were grouped separately. Based on the clinical and provisional diagnosis, the remaining 20 patients who had active lesions were subjected to direct immunofluorscence (DIF) and IIF and were divided into four groups. Biopsy specimens were taken from the periphery of the lesions and were examined by both conventional light microscopic and DIF methods. Five milliliters of venous blood was collected from each patient and were subjected to IIF.

Results: Histopathological diagnosis was consistent with direct immunofluorescence study in 15 cases (75%). The various immunofluorescence patterns observed in our study were consistent with those described by various authors in standard textbooks and articles.

Conclusion: Histopathology remains gold standard for most of the diseases, it is recognized from this study that not all lesions are amenable to definitive histopathological diagnosis thus; DIF can provide a valuable additional criterion in diagnosis.

Keywords: Immunofluorescence; lichen planus; pemphigus.

Chart 1

Direct immunofluorscence

Chart 2

Indirect immunofluorescence

Figure 1

Intercellular space deposition of IgG in the epithelium (DIF) pemphigus

Figure 2

Complement (C3) found scattered in the wall of the bullae (DIF) pemphigus

Figure 3

Granular fluorescence of IgG in the intercellular space of spinosum (IIF) pemphigus

Figure 4

Linear and continuous band of C3 deposit along the basement membrane zone (BMZ) (DIF) pemphigoid

Figure 5

Linear deposits of fibrin along the BMZ (DIF) pemphigoid

Figure 6

Fibrin deposition along the BMZ extending as irregular strands into the superficial lamina propria (DIF)

Figure 7

Linear deposits of fibrin along the BMZ (DIF)

Figure 8

Linear deposition of IgG along the BMZ (DIF)

Figure 9

Linear deposition of C3 along the BMZ (DIF)

Figure 10

Linear deposition of IgM along the BMZ (DIF)