Continuous dermoepidermal junction IgM detected by direct immunofluorescence: a report of nine cases

BACKGROUND

Although a linear IgM dermatosis of pregnancy has been reported, other authors have not found evidence for a distinct linear IgM dermatosis.

OBJECTIVE

We set out to determine whether or not continuous dermoepidermal junction IgM deposition detected by direct immunofluorescence was indicative of a specific disease.

METHODS

We collected nine cases during a 9-year period in which biopsy specimens for direct immunofluorescence revealed continuous linear IgM at the dermoepidermal junction in the absence of other immunoglobulins. In all of these cases the medical record was available for review.

RESULTS

Clinical correlation revealed that these patients had a heterogeneous group of diseases with urticaria and leukocytoclastic vasculitis being most common. No diagnostic specificity could be ascribed to the linear IgM pattern, although six of our nine cases could be considered manifestations of a hypersensitivity response (e.g., urticaria, leukocytoclastic vasculitis, pigmented purpuric dermatosis, or hypersensitivity dermatitis).

CONCLUSION

Pathologists and dermatologists should be aware that linear IgM can be seen in a variety of clinical settings. The etiopathogenic significance of this finding, if any, remains to be determined. At present, the finding must be viewed as nonspecific.

Relapsing polychondritis: a case diagnosed by direct immunofluorescence and coexisting with pseudocyst of the auricle

A case of relapsing polychondritis with perichondrial IgG and C3, dermoepidermal IgG, and a coexisting pseudocyst of the auricle is reported. The use of direct immunofluorescence testing in establishing a diagnosis of relapsing polychondritis and the expected findings are reviewed. In some cases direct immunofluorescence may allow a diagnosis of relapsing polychondritis before clinical criteria or a routine histologic evaluation suggests a definite diagnosis.

Clinical features of Behçet's disease. Report of four cases

Behçet's disease is a multisystem inflammatory disorder of unknown etiology. The unifying histologic reaction pattern is a leukocytoclastic vasculitis that affects predominantly the skin, oral mucosa, and eyes. Many other sites of involvement have been reported but are inconsistently found in individual patients. Early recognition and treatment of Behçet's disease may help prevent devastating permanent sequelae such as blindness. Because oral involvement is often the first manifestation of this disorder, dental practitioners are in a unique position to help these patients. We report four cases of Behçet's disease in North American patients. Diagnostic criteria and treatment options are reviewed.

PUVA therapy

PUVA is an acronym for psoralen plus ultraviolet-A radiation. This form of photochemical therapy is commonly used in the treatment of psoriasis and vitiligo, but it is also beneficial in other dermatologic diseases. An understanding of psoralen's mechanism of action and the unique properties of the various psoralen preparations is important in ensuring optimal results with this therapy.

Case report and review of resolved fusariosis

Erythematous macules, nonpalpable and palpable purpura, and flaccid pustules developed in a 59-year-old man with acute lymphocytic leukemia 8 days after reinduction chemotherapy with cytosine arabinoside and daunorubicin. Tissue and blood cultures grew Fusarium proliferatum, and a skin biopsy specimen revealed fungal vasculitis. Anemia and muscle weakness accompanied the disseminated infection, for which the patient received granulocyte transfusions and amphotericin B, ketoconazole, rifampin, and griseofulvin. Skin lesions and fungemia resolved with recovery of the bone marrow, and 51 days after the completion of his chemotherapy he returned home. If promptly recognized and aggressively treated, disseminated fusariosis is responsive to therapy. Infection with Fusarium species should be suspected in profoundly neutropenic patients in whom disseminated palpable purpura and myositis develop concomitantly.

Disseminated aspergillosis presenting as a skin abscess

An immunocompromised patient presented with chronic low back pain as the initial symptom and a subcutaneous abscess as the initial sign of disseminated aspergillosis. With the rising incidence of immunocompromised patients, cutaneous manifestation of aspergillosis may become more common.

Iatrogenic myelomonocytic leukemia following melphalan treatment of scleromyxedema

We report the case of a patient with scleromyxedema with abnormal monoclonal gamma globulin of the kappa type who was treated with melphalan (Alkeran), an alkylating agent. After nine and one-half years of therapy, the patient showed myelomonocytic leukemia. The risk of secondary malignancies must be considered when weighting the benefits and risks of melphalan treatment.

Skin metastases in cancer patients

Although every cancer may cause skin metastases, some do so more frequently. Proper diagnosis can lead to early detection of a previously unrecognized malignancy. Autopsy data from 7,518 patients with internal cancer were analyzed, and the findings were compared with the literature.