Oral pemphigus vulgaris: an immunofluorescent study of fifty-eight cases

Oral mucosa biopsy specimens and sera from fifty-eight patients with pemphigus vulgaris limited to the oral cavity were studied by the direct and indirect immunofluorescence technique. Direct immunofluorescence demonstrated intercellular substance (ICS) deposition of IgG, either alone or in combination with C3, IgA, and IgM, in fifty-seven out of fifty-eight (98.3 per cent) oral mucosa biopsy specimens examined. At the time of initial evaluation circulating ICS antibodies were detected in twenty-eight out of fifty-eight patients (48.3 per cent) when a compound animal epithelial tissue was used as substrate. However, when normal human oral mucosa was used as substrate, circulating ICS antibodies were observed in fifty out of fifty-eight patients (86.2 per cent). It is concluded that direct and indirect immunofluorescence is a valuable diagnostic test in the early diagnosis of oral pemphigus vulgaris. In addition, normal human oral mucosa is a more appropriate substrate than animal epithelial tissue.