Diagnosis of autoimmune subepidermal bullous diseases with mucous membrane involvement based on laser-scanning confocal microscopy.

Abstract

BACKGROUND:

Mucosal involvement in autoimmune subepidermal blistering disorders (ASBD) may represent the only or predominant localization. Circulating autoantibodies are detected in 50% cases.

OBJECTIVE:

The aim of this study was to evaluate the usefulness of fluorescence overlay antigen mapping by laser-scanning confocal microscopy (FOAM-LSCM) to identify ASBD with mucosal involvement in oral mucosa specimens.

MATERIALS & METHODS:

Thirty-two ASBD patients, diagnosed based on direct immunofluorescence between 2006 and 2016, were enrolled. Localization of IgG deposits bound at the basement membrane zone, relative to laminin-332 and collagen IV localization, was assessed in vivo.

RESULTS:

FOAM-LSCM disclosed four different immunofluorescence patterns. IgG deposits were located above laminin-332, as in bullous pemphigoid (BP-type), in 19% cases and co-localized with laminin-332 (anti-laminin-332-type) in 6% cases. IgG deposits were found below laminin-332 and above collagen IV (mucous membrane pemphigoid-type) in 59% cases, and below collagen IV (epidermolysis bullosa acquisita-type) in 16%. Circulating antibodies were found in 56% cases.

CONCLUSION:

The FOAM-LSCM method should be used in order to obtain a definitive diagnosis of ASBD with mucosal involvement, particularly in the presence of negative circulating antibodies.

• Authors: Katarzyna Wozniak, Beata Jakubowska, Agnieszka Kalinska-Bienias, Takashi Hashimoto, Norito Ishii, Cezary Kowalewski
• Journal: European journal of dermatology : EJD (Eur J Dermatol) Vol. 30 Issue 5 Pg. 516-523 (Oct 01 2020) ISSN: 1952-4013 [Electronic] France
• PMID: 32972911 (Publication Type: Journal Article)

Chemical References

• Autoantibodies
• Cell Adhesion Molecules
• Collagen Type IV
• Immunoglobulin G

Topics

• Adult
• Aged
• Aged, 80 and over
• Autoantibodies (blood)
• Basement Membrane (immunology)
• Cell Adhesion Molecules (immunology)
• Collagen Type IV (immunology)
• Epidermolysis Bullosa Acquisita (diagnostic imaging, immunology)
• Female
• Fluorescent Antibody Technique, Direct
• Humans
• Immunoglobulin G (analysis)
• Male
• Microscopy, Confocal
• Middle Aged
• Mouth Mucosa (diagnostic imaging, immunology)
• Kalinin