Direct Immunofluorescence (Dif) Microscopy In Cutanous Small Vessel Vasculitis: A Single Institution Experiences
Abstract
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.
References
- 1. Carlson JA, Ng BT, Chen KR. Cutaneous vasculitis update: diagnostic criteria, classification, epidemiology, etiology, pathogenesis, evaluation and prognosis. Am. J. Dermatopathol. 2005;27(6):504–528. 2. McLaren JS, McRorie ER, Luqmani RA. Diagnosis and assessment of systemic vasculitis. Clin Exp Rheumatol. 2002;20(6):854-62. 3. Carlson JA. The histological assessment of cutaneous vasculitis. Histopathology. 2010;56(1):3-23. 4. Gonzalez-Gay MA, Garcia-Porrua C, Salvarani C, Lo Scocco G, Pujol RM. Cutaneous vasculitis: a diagnostic approach. Clin Exp Rheumatol. 2003;21(6 Suppl 32):S85-88. 5. Feasel P, Billings SD, Bergfeld WF, Piliang MP, Fernandez AP, Ko JS. Direct immunofluorescence testing in vasculitis - a single institution experience with Henoch Schönlein Purpura. J Cutan Pathol. 2018;45(1):16-22. 6. Nandeesh B, Tirumalae R. Direct immunofluorescence in cutaneous vasculitis: experience from a referral hospital in India. Indian J Dermatol. 2013;58(1):22-25. 7. İlter N, Adışen E. Kutanöz vaskülitler. Türkderm 2010;44:50-60. 8. Otten JV, Hashimoto T, Hertl M, Payne AS, Sitaru C. Molecular diagnosis in autoimmune skin blistering conditions. Curr Mol Med 2014;14(1):69-95. 9. Jennette JC, Falk RJ, Bacon PA, Basu N, Cid MC, Ferrario F, et al. 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum. 2013;65(1):1-11. 10. Takatu CM, Heringer APR, Aoki V, Valente NYS, de Faria Sanchez PC, de Carvalho JF3, et al. Clinicopathologic correlation of 282 leukocytoclastic vasculitis cases in a tertiary hospital: a focus on direct immunofluorescence findings at the blood vessel wall. Immunol Res. 2017;65(1):395-401. 11.Valencia-Guerrero A, Deng A, Dresser K, Bouliane G, Cornejo KM. The Value of Direct Immunofluorescence on Proteinase-Digested Formalin-Fixed Paraffin-Embedded Skin Biopsies. Am J Dermatopathol. 2017 Aug 9. doi: 10.1097/DAD.0000000000000934. 12. Alalwani M, Billings SD, Gota CE. Clinical significance of immunoglobulin deposition in leukocytoclastic vasculitis: a 5-year retrospective study of 88 patients at cleveland clinic. Am J Dermatopathol. 2014;36(9):723-9. 13. Mysorekar VV, Sumathy TK, Shyam Prasad AL. Role of direct immunofluorescence in dermatological disorders. Indian Dermatol Online J. 2015;6(3):172-80. 14. Arslan Z, Özmen S, Sürmeli S, Arda N. Atypical acute urticaria in children and its relationship with urticarial vasculitis. Turk J Med Sci 2011; 41 (1): 87-92 15. Niflioğlu GG, Lebe B. Pemphigoid Gestationis: Light Microscopic and Direct Immunofluorescense Findings. Turk Patoloji Derg. 2014;30(2):152-154. 16. Şahin EB, Hapa A, Elçin G, Karaduman A, Ersoy Evans S, Erkin G, et al. Lökositoklastik Vaskülit: 60 Hastanın Geriye Dönük Analizi. Turk J Dermatol 2011; 5: 85-91 17. Lebe B, Gül Nıflıoğlu G, Seyrek S, Ellıdokuz H. Evaluation of clinical and histopathologic/direct immunofluorescence diagnosis in autoimmune vesiculobullous dermatitis: utility of direct immunofluorescence. Turk Patoloji Derg. 2012;28(1):11-16. 18. Kavala M, Zindancı İ. The Management of Pemphigus Patients: Clinical Remission, Discontinuation of Therapy and Our Experience. Türkderm. 2008; 42(1): 13-14
KUTANÖZ KÜÇÜK DAMAR VASKÜLİTLERİNDE DİREKT İMMUNFLORASAN (DİF) MİKROSKOPİ BULGULARI: TEK MERKEZE AİT DENEYİMLER
Abstract
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.
References
- 1. Carlson JA, Ng BT, Chen KR. Cutaneous vasculitis update: diagnostic criteria, classification, epidemiology, etiology, pathogenesis, evaluation and prognosis. Am. J. Dermatopathol. 2005;27(6):504–528. 2. McLaren JS, McRorie ER, Luqmani RA. Diagnosis and assessment of systemic vasculitis. Clin Exp Rheumatol. 2002;20(6):854-62. 3. Carlson JA. The histological assessment of cutaneous vasculitis. Histopathology. 2010;56(1):3-23. 4. Gonzalez-Gay MA, Garcia-Porrua C, Salvarani C, Lo Scocco G, Pujol RM. Cutaneous vasculitis: a diagnostic approach. Clin Exp Rheumatol. 2003;21(6 Suppl 32):S85-88. 5. Feasel P, Billings SD, Bergfeld WF, Piliang MP, Fernandez AP, Ko JS. Direct immunofluorescence testing in vasculitis - a single institution experience with Henoch Schönlein Purpura. J Cutan Pathol. 2018;45(1):16-22. 6. Nandeesh B, Tirumalae R. Direct immunofluorescence in cutaneous vasculitis: experience from a referral hospital in India. Indian J Dermatol. 2013;58(1):22-25. 7. İlter N, Adışen E. Kutanöz vaskülitler. Türkderm 2010;44:50-60. 8. Otten JV, Hashimoto T, Hertl M, Payne AS, Sitaru C. Molecular diagnosis in autoimmune skin blistering conditions. Curr Mol Med 2014;14(1):69-95. 9. Jennette JC, Falk RJ, Bacon PA, Basu N, Cid MC, Ferrario F, et al. 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum. 2013;65(1):1-11. 10. Takatu CM, Heringer APR, Aoki V, Valente NYS, de Faria Sanchez PC, de Carvalho JF3, et al. Clinicopathologic correlation of 282 leukocytoclastic vasculitis cases in a tertiary hospital: a focus on direct immunofluorescence findings at the blood vessel wall. Immunol Res. 2017;65(1):395-401. 11.Valencia-Guerrero A, Deng A, Dresser K, Bouliane G, Cornejo KM. The Value of Direct Immunofluorescence on Proteinase-Digested Formalin-Fixed Paraffin-Embedded Skin Biopsies. Am J Dermatopathol. 2017 Aug 9. doi: 10.1097/DAD.0000000000000934. 12. Alalwani M, Billings SD, Gota CE. Clinical significance of immunoglobulin deposition in leukocytoclastic vasculitis: a 5-year retrospective study of 88 patients at cleveland clinic. Am J Dermatopathol. 2014;36(9):723-9. 13. Mysorekar VV, Sumathy TK, Shyam Prasad AL. Role of direct immunofluorescence in dermatological disorders. Indian Dermatol Online J. 2015;6(3):172-80. 14. Arslan Z, Özmen S, Sürmeli S, Arda N. Atypical acute urticaria in children and its relationship with urticarial vasculitis. Turk J Med Sci 2011; 41 (1): 87-92 15. Niflioğlu GG, Lebe B. Pemphigoid Gestationis: Light Microscopic and Direct Immunofluorescense Findings. Turk Patoloji Derg. 2014;30(2):152-154. 16. Şahin EB, Hapa A, Elçin G, Karaduman A, Ersoy Evans S, Erkin G, et al. Lökositoklastik Vaskülit: 60 Hastanın Geriye Dönük Analizi. Turk J Dermatol 2011; 5: 85-91 17. Lebe B, Gül Nıflıoğlu G, Seyrek S, Ellıdokuz H. Evaluation of clinical and histopathologic/direct immunofluorescence diagnosis in autoimmune vesiculobullous dermatitis: utility of direct immunofluorescence. Turk Patoloji Derg. 2012;28(1):11-16. 18. Kavala M, Zindancı İ. The Management of Pemphigus Patients: Clinical Remission, Discontinuation of Therapy and Our Experience. Türkderm. 2008; 42(1): 13-14
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | June 1, 2018 |
| Submission Date | January 15, 2018 |
| Acceptance Date | February 14, 2018 |
| Published in Issue | Year 2018 Volume: 25 Issue: 2 |
Süleyman Demirel Üniversitesi Tıp Fakültesi Dergisi/Medical Journal of Süleyman Demirel University is licensed under Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International.