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Published on: May 31, 2017
Cutaneous leukocytoclastic vasculitis: the yield of direct immunofluorescence study
Kanokvalai Kulthanan1, Sumruay Pinkaew, Sukhum Jiamton
1Department of Dermatology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. sikkt@mahidol.ac.th
Insights
Direct immunofluorescence (DIF) studies show a 76% positive yield in diagnosing leukocytoclastic vasculitis (LCV) when biopsies are taken within one week of lesion onset. Early biopsy is crucial, as positive DIF results decrease with lesion age.
Area of Science:
- Dermatology
- Immunopathology
- Pathology
Background:
- Leukocytoclastic vasculitis (LCV) is a recognized clinico-pathological condition.
- Previous direct immunofluorescence (DIF) studies indicated diagnostic utility primarily in early disease stages.
Purpose of the Study:
- To determine the diagnostic yield of DIF in LCV across various disease stages.
- To characterize the patterns of DIF findings in LCV patients.
Main Methods:
- A cohort of 100 LCV patients was studied retrospectively.
- Direct immunofluorescence analysis was performed on skin biopsies.
Main Results:
- A 76% positive yield for DIF was observed in LCV patients.
- Immunoreactive deposits, predominantly C3, were detected in blood vessel walls.
- Biopsies performed within one week of lesion onset showed higher positive DIF rates.
Conclusions:
- DIF is a valuable diagnostic tool for LCV, with a high positive yield when performed within the first week of symptom onset.
- The diagnostic yield of DIF decreases with increasing age of skin lesions.
Background:
Leukocytoclastic vasculitis (LCV) is a clinico-pathological entity. Previous direct immunofluorescence study (DIF) studies of vasculitis showed positive findings mainly in the early stage of the disease.
Objective:
To study the positive yield and patterns of DIF in patients with various stages of LCV.
Design:
One hundred patients with LCV who attended the Department of Dermatology, Siriraj Hospital from 1997 to 2000 were enrolled in the study.
Results:
The study showed immunoreactive deposits in blood vessel walls in 76 cases (76%). Forty seven per cent of patients showed immunoreactant deposit only in superficial blood vessel walls, 3% had deposits only in deep blood vessel walls. Superficial and deep blood vessel wall deposits were seen in 26%. Dermo-epidermal deposit in addition to blood vessel wall deposit was found in 39%. The most common immunoreactive deposit was C3 (71%), followed by IgM (35%), IgA (12%) and IgG (8%) respectively. The age of the skin lesions at the time of biopsy ranged from 1 to 7 days. 82% of patients with one day old lesions showed immunoreactive deposits in the blood vessel walls and 74% of the group with lesions aged 2-7 days at the time of biopsy showed immunoreactive deposits in the blood vessel walls.
Conclusion:
The present study showed a 76% positive yield for DIF study in patients with LCV when biopsies were performed within one week of onset. There was a tendency for the percentage of positive DIF results to decline when the biopsy was performed on lesions that were more than 1 day old.
