Direct Immunofluorescence (Dif) Microscopy In Cutanous Small Vessel Vasculitis: A Single Institution Experiences

Yıl 2018, Cilt: 25 Sayı: 2, 176 - 184, 01.06.2018

Pembe Oltulu , Ayşenur Uğur , İlkay Özer Fahriye Kılınç , Hacı Hasan Esen , Sıdıka Fındık , Arzu Ataseven , Sinan İyisoy Şükrü Balevi Mustafa Cihat Avunduk

https://doi.org/10.17343/sdutfd.379112

Öz

Background: İmmun deposits (especially IgG, IgM, IgA and Compleman C3) can be observed under direct immunofluorescence microscopy (DIF) in many patients with cutaneous small vessel vasculitis (CSV). There are some studies reporting various positivity rates in the literature. İn this study, we aimed to present the results of DIF microscopy of CSV cases in our ınstitute. Materyal and Methods: A total of 121 patients with CSV were included retrospectively in this study. All the cases have skin biopsy for DIF and histopathological examination and clinical data. A total of 6 groups were formed considering the clinical data of the cases and the Chapel Hill Consensus Conference vasculitis classification. The accumulation of at least one of the immun deposits (IgG, IgM, IgA ve C3) in basal membrane or perivascular (PV) field was assessed as ‘DIF positive’. The relationship between the presence of eosinophil and leucocytoclasia and the accumulation of immun deposits was investigated statistically. Results: DIF was positive in 58.7% (n:71/121) cases. DIF was positive in 50.9% (n: 28/55) of leukocytoclastic vasculitis cases, 67.4% (n: 31/46) of nonspecific CV cases, 44.4% (n: 4/9) of urticarial vasculitis cases and 75% of livedoid vasculitis cases (n: 3/4), 100% (n: 5/5) of henoch schonlein purpura (HSP) cases. There was not any accumulation in vasculopathy cases (n:2). There was not any relationship statistically between the presence of eosinophil and leucocytoclasia and the accumulation of immun deposits. The highest immun accumulation was C3 and the rate of IgA accumulation in HSP was 100%. Conclusion: In CSVs, high DIF positivity rates (especially C3) were determined. The determination of IgA deposits with DIF is very important for diagnosis of HSP. Performing of DIF in addition to clinical and histopathologic examination may be useful in CSVs. 

Anahtar Kelimeler

cutaneous, small vessel, vasculitis, direct immunofluorescence, immun deposit

KUTANÖZ KÜÇÜK DAMAR VASKÜLİTLERİNDE DİREKT İMMUNFLORASAN (DİF) MİKROSKOPİ BULGULARI: TEK MERKEZE AİT DENEYİMLER

Öz

Giriş: Tamamında
depolanma gözlenmese de, dermatologlar pekçok  kutanöz vaskülit (KV) ön tanılı hastaları için
direkt immunflorosan mikroskopi (DİF) altında immun depolanmaların bulunup bulunmadığını
öğrenmek ister. Dünya literatüründe çeşitli pozitiflik oranları bildiren
çalışmalar mevcuttur. Bu çalışma ile kliniğimize ait küçük damar KV’lerin DİF
mikroskopi sonuçlarını sunmayı amaçladık.

Gereç ve yöntem: Vaskülit
öntanısı ile biopsi ve DİF tetkiki yapılan, histopatolojik olarak küçük damar
KV’i mevcut olan toplam 121 vaka retrospektif olarak çalışmaya dahil edildi. Olgular
klinik verileri ve Chapel Hill Consensus Conference vaskülit sınıflaması
gözönünde bulundurularak toplam 6 gruba ayrıldı. Bazal membran yada perivasküler
(PV) alanda en az bir depolanma ‘DİF pozitif’ olarak kabul edildi. Tüm
olgularda DİF IgG, IgM, IgA ve Compleman C3 depolanmalarının dağılımları,
oranları ve gruplarda en az bir immun depozitin bulunma durumu belirlendi. Lökositoklazis
bulunduran yada eozinofil bulunduranlar ayrı grup yapılarak diğerleri ile immun
depolanmalar açısından istatistiksel olarak karşılaştırıldı.

Bulgular: Tüm
olgularda DİF pozitifliği %58.7 (n:71/121) idi. Lökositoklastik
vaskülit olgularının %50.9’unda (n:28/55), nonspesifik KV olgularının %67.4’ünde
(n:31/46), ürtikeryal vaskülit olgularının %44.4 (n:4/9)’ünde, livedoid
vaskülit olgularının %75 (n:3/4)’inde, henoch schonlein purpurası (HSP)
olgularının (n:5/5) %100’ünde DİF
pozitifti. 2 vaskülopati olgusunda depolanma yoktu. Lökositoklazis ve eozinofil
mevcudiyeti ile immun depolanmalar arasında herhangi bir ilişki yoktu. En fazla
biriken depozit C3 iken, HSP olgularında IgA depolanma oranı %100’dü.

Sonuç: Özellikle
HSP olgularında DİF ile IgA depozit tespiti tanı için oldukça önemlidir. Diğer
küçük damar KV’lerinde %100 olmasa da gözardı edilemeyecek yüksek DİF
pozitiflik oranları (özellikle C3) tespit edildi. KV’lerde DİF tetkikinin, klinik
ve histopatolojik incelemeye ek olarak uygulanması faydalıdır.

Anahtar Kelimeler

kutanöz vaskülit, küçük damar, direkt immunflorasan, immun depozit, C3, , lökositoklastik

Kaynakça

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