title: Epidermolysis bullosa acquisita diagnosed by direct immunoelectron microscopy of the conjunctiva.
abstract: OBJECTIVE
  To describe for the first time the direct immunoelectron microscopic pattern of immune deposits on the conjunctival basement membrane in epidermolysis bullosa acquisita (EBA).
  
  
  METHODS
  Case reports.
  
  
  METHODS
  Two patients.
  
  
  METHODS
  Epidermolysis bullosa acquisita associated with cicatrizing conjunctivitis.
  
  
  METHODS
  Direct immunofluorescence and direct immunoelectron microscopy without freezing on conjunctival and skin biopsy specimens, indirect immunofluorescence, Western immunoblot analysis.
  
  
  RESULTS
  Results of direct immunoelectron microscopic examination of the conjunctiva showed the presence of immune deposits in the anchoring fibril zone, just beneath the lamina densa, in both patients. This finding was the same as the direct immunoelectron microscopic pattern shown in the skin of these patients, which is known to be very specific for EBA. Direct immunofluorescence was positive in the conjunctiva of only one patient. Indirect immunofluorescence and Western immunoblot analysis failed to detect circulating autoantibodies.
  
  
  CONCLUSIONS
  Direct immunoelectron microscopy on the conjunctiva is a useful diagnostic tool to differentiate EBA from other related autoimmune mucocutaneous blistering diseases.
authors.affiliation: Department of Ophthalmology, Hospital Bichat, Paris, France.
authors.forename: T
authors.initials: T
authors.lastname: Hoang-Xuan
authors.forename: H
authors.initials: H
authors.lastname: Robin
authors.forename: M
authors.initials: M
authors.lastname: Heller
authors.forename: F
authors.initials: F
authors.lastname: Caux
authors.forename: C
authors.initials: C
authors.lastname: Prost
mesh_terms: D000328:Adult; D000936:Antigen-Antibody Complex / Q000648:ultrastructure*; D001485:Basement Membrane / Q000648:ultrastructure; D015153:Blotting, Western; D003176:Complement C3 / Q000276:immunology; D003228:Conjunctiva / Q000648:ultrastructure*; D003231:Conjunctivitis / Q000175:diagnosis*; D016107:Epidermolysis Bullosa Acquisita / Q000175:diagnosis*; D005260:Female; D019085:Fluorescent Antibody Technique, Direct; D006801:Humans; D007143:Immunoglobulin Heavy Chains / Q000276:immunology; D008297:Male; D016253:Microscopy, Immunoelectron / Q000379:methods; D008875:Middle Aged; D011347:Procollagen / Q000276:immunology
chemical_list: D000936:Antigen-Antibody Complex; D003176:Complement C3; D007143:Immunoglobulin Heavy Chains; D011347:Procollagen