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. 2019 Mar-Apr;64(2):101-105.
doi: 10.4103/ijd.IJD_515_17.

A Clinicopathological and Immunofluorescence Study of Intraepidermal Immunobullous Diseases

Keya Basu  1 , Moumita Chatterjee  1 , Abhishek De  2 , Moumita Sengupta  1 , Chhanda Datta  1 , Pradip Mitra  1
Affiliations

A Clinicopathological and Immunofluorescence Study of Intraepidermal Immunobullous Diseases

Keya Basu et al. Indian J Dermatol. 2019 Mar-Apr.

Abstract

Context: Autoimmune blistering diseases (AIBDs) are characterized by autoantibodies directed against antigens of skin. Direct immunofluorescence (DIF) study helps in confirming the diagnosis where histopathology alone is noncontributory.

Aims: This study aimed to evaluate the clinicopathological and DIF features of intraepidermal AIBD and to assess their relative diagnostic significance.

Materials and methods: It was an institution-based observational study. A total of 34 patients were studied over a period of 1½ years in the Department of Pathology in collaboration with the Department of Dermatology of a tertiary care hospital. The clinical, pathological, and DIF features were evaluated and documented.

Statistical analysis: Data were analyzed by statistical tests using GraphPad InStat.

Results: Pemphigus vulgaris (PV) was the predominant type with 18 (53%) cases followed by 15 (44%) cases of pemphigus foliaceus (PF) and a single case of pemphigus erythematosus (PE). The age of the patients ranged from 17 to 85 years. Overall, there was a female preponderance in the study group. The most common presenting feature was pruritus (58.82%). Tzanck smear showed the presence of acantholytic cells in thirty (88.24%) patients. Characteristic histopathological features were present in all the cases of PV and PF except one case of PF which was found to be a case of PE. DIF study showed intraepidermal deposition of intercellular immunoglobulin G (IgG) and C3 both in PV and PF. The case of PE showed epidermal "antinuclear antibody" staining with IgG.

Conclusion: Immunofluorescence study may be used as an additional tool for confirmation of diagnosis where histopathology alone is inconclusive.

Keywords: Direct immunofluorescence; histopathology; immunobullous disorder; tzanck smear.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Clinical picture and photomicrographs of pemphigus vulgaris (a) Flaccid, grouped vesicles over the back; (b) Suprabasal blister with row of tombstone appearance (H and E, ×100); (c) Intercellular staining of epidermis with immunoglobulin G in pemphigus vulgaris (direct immunofluorescence, ×400); (d) Tzanck smear showing acantholytic cells (Giemsa, ×400)
Figure 2
Figure 2
Clinical picture and photomicrographs of pemphigus foliaceus (a) Scaly and crusted lesions over the trunk; (b) Subcorneal blister (H and E, ×100); (c) Intercellular staining of epidermis with immunoglobulin G, more intense in the upper epidermis in pemphigus foliaceus (direct immunofluorescence, ×400); (d) Tzanck smear showing acantholytic cells (Giemsa, ×400)
Figure 3
Figure 3
Clinical picture of pemphigus vulgaris
Figure 4
Figure 4
(a) oral mucosal lesion of pemphigus vulgaris, (b) oral mucosal lesion of pemphigus foliaceus
See this image and copyright information in PMC

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