DIF Findings in Systemic Lupus Erythematosus Table 221

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The DIF findings in biopsy samples obtained from typical SLE lesions are similar to those seen in DLE or SCLE: IgG, IgM, IgA, and C3 are most frequently detected, but other complement components and fibrin may be also present. The intensity of the LBT result in lesional skin was shown to correlate with serum titers of anti-DNA antibodies and with disease activity (Sontheimer and Gilliam 1979). As in other forms of

Fig. 22.3. Perivascular deposits of IgG around a dermal vessel in lesional skin (systemic lupus erythematosus)

Fig. 22.3. Perivascular deposits of IgG around a dermal vessel in lesional skin (systemic lupus erythematosus)

LE,the pattern of immune deposits along the DEJ may be bandlike, linear, or granular. In lesional skin of patients with SLE and active disease before systemic immunosuppressive treatment,the LBT result is positive in 90%-100% of biopsy specimens.A negative DIF finding in lesional skin makes a diagnosis of SLE very unlikely. In affected skin from patients with SLE, immune deposits may also be detected in other areas besides the DEJ: cytoid bodies mostly containing IgM or IgA can be present in the papillary dermis; around superficial dermal blood vessels, precipitates of immunoglobulins and complement may be located as in immune complex vasculitis (Fig. 22.3). These vasculitic changes are specific to SLE and are not seen in DLE or SCLE; they are associated with other systemic immune complex-mediated disease processes, with hypocomplementemia and a serious outcome prognosis (Sontheimer and Provost 1997). In nonlesional sun-protected skin of patients with SLE, the probability of a positive LBT result is much higher than in other LE subtypes and has been reported with a frequency between 50% and 90% (Halberg et al. 1982). The predictive value of a positive LBT result for the diagnosis of SLE is most reliable when deposits of IgG are present along the DEJ in biopsy specimens from uninvolved skin (Dahl 1983).

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