title: Immunoelectron microscopy in subepidermal autoimmune bullous diseases: a prospective study of IgG and C3 bound in vivo in 32 patients.
abstract: Thirty-two patients suffering from subepidermal autoimmune bullous disease were studied prospectively by clinical examination and immunoelectron microscopy. Clinically, 1 patient had herpes gestationnis, 14 typical bullous pemphigoid (BP), 3 epidermolysis acquisita (EBA), 3 cicatricial pemphigoid (CP), and 11 patients overlapping clinical diseases. These 11 patients shared clinical features of BP, EBA, or CP and a clinical diagnosis could not be done safely. Immunoelectron microscopy revealed diaminobenzidine deposits in 20 patients on the epidermal side of dermo-epidermal junction in the lamina lucida as in BP. In 5 patients, deposits located mostly under the anchoring fibril zone, in the floor of a sublamina densa dermoepidermal separation for 2 of them, were consistent with a diagnosis of EBA. In 6 patients, deposits were located mostly in the lamina densa, in the floor of a dermoepidermal separation occurring in the lamina lucida for 3 of them. This suggests that some of these 6 patients had neither EBA or BP, but another autoimmune bullous disease again, an uncharacterized component of dermoepidermal junction located in the lamina densa. Finally, a correlation exists between the sites of IgG and/or C3 components on epidermal or dermal side of dermoepidermal junction and the presence or absence of characteristic clinical features such as scar, milia formation, or mucosal involvement.
authors.affiliation: Department of Histology, Hospital Henri Mondor, Créteil, France.
authors.forename: C
authors.initials: C
authors.lastname: Prost
authors.forename: B
authors.initials: B
authors.lastname: Labeille
authors.forename: V
authors.initials: V
authors.lastname: Chaussade
authors.forename: J C
authors.initials: JC
authors.lastname: Guillaume
authors.forename: N
authors.initials: N
authors.lastname: Martin
authors.forename: L
authors.initials: L
authors.lastname: Dubertret
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001327:Autoimmune Diseases / Q000175:diagnosis / Q000276:immunology* / Q000473:pathology; D003176:Complement C3 / Q000032:analysis*; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000032:analysis*; D008297:Male; D008875:Middle Aged; D006559:Pemphigoid Gestationis / Q000276:immunology / Q000473:pathology; D011247:Pregnancy; D011446:Prospective Studies; D012867:Skin / Q000276:immunology / Q000473:pathology; D012872:Skin Diseases, Vesiculobullous / Q000175:diagnosis / Q000276:immunology* / Q000473:pathology
chemical_list: D003176:Complement C3; D007074:Immunoglobulin G