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Bk P, Panwar H, Joshi D, Asati D, Chaurasia JK, Vamseekrishna D, Rathinam BA, Kapoor N. Diagnostic Utility of Direct Immunofluorescence on Paraffin-Embedded Skin Biopsy Samples for the Diagnosis of Autoimmune Vesiculobullous Lesions. Cureus 2024; 16:e56916. [PMID: 38665766 PMCID: PMC11042922 DOI: 10.7759/cureus.56916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
Background Autoimmune vesiculobullous diseases (AIBDs) are a group of diseases characterized by blisters of the skin/mucosa due to the presence of circulating autoantibodies against antigens in the epidermis or the dermo-epidermal junction. Direct immunofluorescence (DIF) for immunoglobulin (Ig)G, IgC3, and IgA on fresh-frozen tissue is the gold standard diagnostic test for AIBDs. However, DIF in the absence of frozen tissue is challenging for the diagnosis of AIBDs. This study aimed to analyze the practical utility of DIF using paraffin-embedded skin biopsy rather than fresh frozen tissue for the diagnosis of AIBDs. Methodology This cross-sectional comparative study included 30 cases of AIBDs. DIF for IgG and IgA was performed on paraffin-embedded tissue (PE-DIF) after proteinase digestion on histopathologically confirmed 15 pemphigus vulgaris (PV), three pemphigus foliaceous (PF), four bullous pemphigoid (BP), three dermatitis herpetiformis (DH), three subcorneal pustular dermatosis (SCPD), and one case each of linear IgA disease and pemphigoid gestationis (PG). PE-DIF staining pattern was compared with the DIF on fresh frozen tissue (FF-DIF). Results All cases of PV and PF showed an intercellular IgG chicken wire staining pattern similar to FF-DIF. However, background staining was more intense in PV cases while less intense in PF cases. Three BP cases showed linear IgG staining in PE-DIF. DH, SCPD, linear IgA disease, and PG cases did not show IgG positivity. Out of three DH cases, two cases showed granular IgA positivity while linear IgA positivity along the basement membrane was seen in a single case of linear IgA disease. Negative IgG staining was observed in SCPD. Immunofluorescence in PE-DIF was rapidly deteriorating than in FF-DIF. Conclusions DIF done on paraffin-embedded tissue can be used as a supplement and salvage technique with histopathology for the diagnosis of AIBDs, particularly when a cryostat facility for frozen tissue is not available and the patient is unable to undergo a second biopsy procedure.
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Affiliation(s)
- Praveen Bk
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Hemlata Panwar
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Deepti Joshi
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Dinesh Asati
- Department of Dermatology, STD and Leprosy, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Jai K Chaurasia
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Dega Vamseekrishna
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Bertha A Rathinam
- Department of Anatomy, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Neelkamal Kapoor
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
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García-Lechuga M, Vega-Memije ME, Montiel-Rangel AI, Torres-González A, Rangel-Gamboa L. Utility of IgG4 immunohistochemistry detection in pemphigus diagnosis. SAGE Open Med Case Rep 2022; 10:2050313X211072982. [PMID: 35070321 PMCID: PMC8777340 DOI: 10.1177/2050313x211072982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 12/21/2021] [Indexed: 11/16/2022] Open
Abstract
Pemphigus includes a group of blistering autoimmune diseases that affect the skin and mucosa, characterized by the formation of epidermal bullous and the presence of antibodies against binding proteins. Pemphigus is classified according to clinical presentation, target molecule, and IgG production as pemphigus vulgaris, foliaceous, IgA-pemphigus, and paraneoplastic pemphigus. Thus, the identification of autoantibodies class and site of deposition is mandatory. The gold standard to identify the immune complex deposition is the direct immunofluorescences technique, performed in fresh tissue; unfortunately, this method is unavailable in the regional hospital at the Mexican provinces. Nevertheless, IgG subclass-4 is the prevalence of immunoglobulin in acantholysis. Therefore, this IgG subclass could be detected using IgG4 immunohistochemistry. Because direct immunofluorescences technique is absent in provinces or patients denied a new biopsy to confirm the diagnosis, this work presented pemphigus vulgaris confirmation using the IgG4 immunohistochemistry technique in patients with clinical lesions suggestive of pemphigus vulgaris and intraepidermal blister manifestation in histopathology.
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Affiliation(s)
- Maricela García-Lechuga
- Departamento de Medicina Interna, Hospital General de Zona No.71 “Benito Coquet,” Veracruz, México
| | - María Elisa Vega-Memije
- Departamento de Dermatopatología, Hospital General “Dr. Manuel Gea González,” Ciudad de México, México
| | | | - Andres Torres-González
- Departamento de Medicina Interna, Hospital General de Zona No.71 “Benito Coquet,” Veracruz, México
| | - Lucia Rangel-Gamboa
- Consulta de Dermatología, Luminox Skin Centre, Torre Noox, Ciudad de México, México
- Departamento de Ecología e Agentes Patógenos, Subdirección de Investigación, Hospital General “Dr. Manuel Gea González,” Ciudad de México, México
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