Direct immunofluorescence in cutaneous vasculitis: Experience from a referral hospital in India

Abstract

Background:Cutaneous vasculitis is commonly recognized and biopsied, owing to ease of access. Most biopsies are also subjected to direct immunofluorescence (DIF), though the rates of positivity vary. This is an attempt to assess the utility of DIF and glean data that will help optimize the test.Objective:To assess the diagnostic utility of DIF in cutaneous vasculitis.Materials and Methods:All cases of suspected cutaneous vasculitis submitted for DIF between 2004 and 2010 were included. Clinical data, histopathologic diagnosis, DIF findings and additional tests such as anti nuclear antibody (ANA), anti neutrophil cytoplasmic antibody (ANCA) (where done) were noted.Results:There were 198 patients in the study group, with a female predominance. Purpura was the commonest clinical presentation. Extracutaneous involvement was noted in 29% of patients’ i.e., joint pain, abdominal pain and hematuria. Leukocytoclastic vasculitis was the commonest histologic diagnosis. DIF showed an overall positivity of 39% (n = 77) with C3 in 26% (n = 52) and IgA in 23% (n = 46) cases. Forty one cases of suspected Henoch Schonlein Purpura (HSP) showed IgA positivity. The timing of biopsy ranged from <3 days to six months, with 38% being done within seven days. DIF was positive in 86% of biopsies performed within seven days of onset of lesions. Sixty percent of patients with extracutaneous manifestations showed deposits. Vascular deposits were also noted in dermatitis herpetiformis, dematomyositis and prurigo.Conclusion:DIF positivity is strongly influenced by the timing of the biopsy and the presence of extracutaneous features. Its clinical value is greatest in patients with HSP, being contributory in 90% of cases. Vascular deposits may be seen in non-vasculitic conditions and need clinicopathologic correlation.

A Study of Aetiological Factors in the Occurrence of Cutaneous Vasculitis in a Tertiary Care Centre in North Kerala

“…9,10 A causal agent or an underlying condition has been reported in 20-85 percent of the cases. 11,12,10,13 Similar to our findings, a previous study from India had found that drugs were the most common aetiological factor in vasculitis. 14 In contrast to our study, some previous studies had shown that antibiotics rather than NSAIDs were responsible for drug-induced vasculitis.…”

Ex vivo confocal laser scanning microscopy: An innovative method for direct immunofluorescence of cutaneous vasculitis

“…DIF microscopy of the lesional skin shows the deposition of immune complexes along the vessel wall, which is of great importance in Henoch‐Schönlein purpura/IgA vasculitis. DIF positivity has been reported to range between 39% and 92% in a few studies conducted on cutaneous vasculitis specimens . Several factors affect the DIF results in vasculitis, including the age of the biopsied lesion and drug intake after the onset of lesions .…”

“…DIF positivity has been reported to range between 39% and 92% in a few studies conducted on cutaneous vasculitis specimens . Several factors affect the DIF results in vasculitis, including the age of the biopsied lesion and drug intake after the onset of lesions . Moreover, a nonspecific DIF positivity has been reported in biopsy specimens from the lower legs in patients without vasculitis .…”

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

“…Daha önce bazı merkezlerde yapılan çalışmalarda, İD'lerden en az bir tanesinin bulunması pozitif kabul edildiğinde, kutanöz vaskülitlerde ve LKV'lerde değişken oranlarda (%20-%70,5) DİF pozitifliği bildirildi (6,8,(9)(10)(11)17). Tüm KV'ler için en düşük oran %20 ile Feasel ve arkadaşlarının geniş vaka serisi içeren (1318 vaka) çalışmasında tespit edilirken (6), en yüksek oran Guerraro ve arkadaşlarının 20 vaka analizinde %70 olarak tespit edilmiştir (17).…”

“…Lökositoklastik değişiklikler (nötrofil parçalanmaları ve nükleer kırıntılar) genellikle mevcuttur (5). Vaskülitlerde damar duvarında immunglobülinler (Ig) veya komplemanlardan (C) oluşan immun depozitler (İD) birikebilir ancak birikmeyen vakalar da mevcuttur Literatürde KV'lerden en çok lökositoklastik vakülitler (LKV) ve henoch schonlein purpurası vaskülitlerinde (HSP) yüksek birikim oranları bildirilmiştir (6,8). Bu çalışmada, histopatolojik ve klinik olarak vaskülit tanısı alan, lökositoklastik değişiklikler içeren ya da içermeyen, küçük damarları etkileyen KV (KKV) vakalarını guruplandı-…”