Erythema multiforme: demonstration of immune complexes in the sera and skin lesions

Abstract

In twenty patients with erythema multiforme we investigated circulating immune complexes and their deposition in the skin lesions. CIq-binding activity was elevated in ten of twenty patients, and the platelet aggregation titre was high in three of twelve tested sera. Decreased levels of C3 were seen in two and of C4 in one out of eighteen patients. Direct immunofluorescence showed a deposition of C3, IgM or IgG in the blood vessel walls of the upper dermis in four of twelve patients. These findings may suggest that transient production of circulating immune complexes and their deposition play an important role in the pathogenesis of this disease.

Erythema multiforme: Clinical spectrum and immunopathogenesis

“…Initial studies of the direct immunofluorescence of skin lesions from erythema multiforme patients [23] have shown delicate granular deposits of C3 alone or with IgM globulin in the microvasculature of the papillary dermis [Fig 2], and this finding has now been documented by other investigators [7,18,20,56]. A summary of results from direct immunofluorescence studies of skin biopsies from erythema multiforme and Stevens-Johnson syndrome patients is given in Table 1.…”

“…Safai et al [42] found depletion of complement components in the blister fluids of two patients with bullous erythema multiforme and speculated that immune complexes might play a role in production of the lesions. Immune complexes can be detected in sera with several different assays, including the Raji cell radioimmunoassay [56], lZSI-Clq binding assay [20], cryoprecipitation [18], and monoclonal rheumatoid factor assay [7]. All of these assays have been used to detect circulating immune complexes in erythema multiforme and Stevens-Johnson syndrome, and findings from several sources are summarized in Table 2.…”

Plasma anaphylatoxin concentrations in inflammatory skin diseases.

“…This disease has also been regarded as an immune complex disease because of the presence of immune complexes in the sera and in the skin lesions (Kazmierowski and Wuepper 1978;Imamura et al 1980). Likewise, no increase was found in any of the patients with bullous pemphigoid, pemphigus foliaceus or linear IgA bullous dermatoses in which auto-antibody-associated immune reaction occurs at the dermo-epidermal junction of the skin (Lever 1979).…”

Suppression of zymosan-induced chemiluminescence of whole blood by conjugates composed of drug, guinea pig skin extracts and sera from patients with suspicious drug eruptions.

“…Imamura et al (1980) reported the presence of circulating immune complexes in some patients with erythema multiforme, and their group postulated that the participation of immune complexes in some kinds of exanthematous drug eruptions was found to show a relatively high serum level of immune complexes . In our present data a relatively high positive rate was also observed in conjugates containing sera from patients with macropapular or erythema multiforme types of drug eruptions (Table 1).…”