Direct Immunofluorescence in Recurrent Aphthous Ulcers and Behçet’s Disease

Abstract

Direct immunofluorescence (IF) investigations in oral aphthae were performed in 17 patients with recurrent aphthous ulcers (RAU) and in 9 patients with Behçet’s disease (BD). In addition, cutaneous hyperreactivity lesions from 2 BD patients were examined. The results were compared to direct IF findings in 28 patients with nonaphthous oral diseases. There was no difference between direct IF on oral aphthae in RAU compared to BD. Deposition of C3 in vessel walls of the subepithelial connective tissue was observed in 13 of 17 patients with RAU and in all patients with BD. IgM deposits in vessel walls were found in 5 RAU and 3 BD patients. Deposition of C1q or C4 was not present. By contrast, IgG and/or IgM, C1q, C3 and C4 were detected in dermal vessel walls of skin hyperreactivity lesions from 2 BD patients. This finding is considered to be a true immune complex vasculitis. Compared to nonaphthous oral lesions, oral aphthae of BD and RAU were characterized by C3 deposition in the subepithelial vessel walls.

O papel da imunofluorescência direta na fisiopatologia e no diagnóstico diferencial da estomatite aftóide recorrente

“…Our study with direct immunofluorescence in 23 patients is in conflict with the findings of these two authors 16,17 and in partial agreement with those from VanHale et al, Malmström et al and Reimer et al 18,19,20 . In our series we could not find specific fluorescence for igG, IgA and Igm on vessel walls and also on the basal membrane zone.…”

“…In 17 cases, Reimer et al 20 did not find fluorescence on the basal membrane for IgG, IgA and IgM; however, in six cases there was fluorescence for C3. The vessel walls did not present fluorescence for igG and IgA; and fluorescence was present in 4 cases for IgM and 13 cases for C3.…”

“…The main physiopathological hypothesis for the origin of RAS lesions are associated with humoral or cellular immunity 4,[15][16][17][18][19][20] . Most of the studies aforementioned, among other exams, used direct immunofluorescence (DIf) in order to try to prove the presence or absence of immunocomplex deposits on the mucosa of patients with RAS.…”

Skin Window Examination According to Rebuck and Cutaneous Pathergy Tests in Patients with Behçet’s Disease

“…The etiology of BD, characterized by vasculitic lesions with possible involvement of skin, oral mucosa, visceral and other organs, is unknown so far [Reimer et al, 1983]. In addition to disturbances of granulocyte functions [Djawari et al, 1981], there is good evidence that a disorder of other ele ments of cellular immunity plays an impor tant role for the pathogenesis of the disease [Haim et al, 1976;Takeuchi et al, 1981;Yazici et al, 1980], The diagnosis of BD primarily depends on the history and the clinical findings, the major diagnostic criteria being recurrent oral aphthae, genital ulcerations and inflam matory ocular as well as cutaneous lesions.…”

“…Additional criteria such as neurological, gas trointestinal and arthritic disorders may complete the clinical picture of BD , The phenomenon of nonspecific cutane ous hyperreactivity is very characteristic of BD [Sobelet al, 1973;Tüzün et al, 1979Tüzün et al, . 1980Yazaki, 1970;Yazici et al 1980], However, it only occurs during active phases of the disease and before starting immuno suppressive treatment [Reimer et al, 1983]. Yazici et al [1980] observed positive pathergy reactions in 82% of their 49 Turkish pa tients with BD.…”