Pre-bisection of a single skin biopsy does not produce technically inadequate specimens for direct immunofluorescence: a review of 3450 specimens

2014 ◽  
Vol 41 (11) ◽  
pp. 890-892
Author(s):  
Ern Loh ◽  
April W. Armstrong ◽  
Maxwell A. Fung
Keyword(s):  
Skin Biopsy ◽  
Direct Immunofluorescence

scholarly journals Exfoliative dermatitis causing diagnostic dilemma: Sibling provides the missing link

2020 ◽  
Vol 2 ◽  
pp. 40-42
Author(s):  
Soumya Jagadeesan ◽  
Malini Eapen ◽  
Aditi Karunakaran ◽  
Vinitha Panicker ◽  
Gopikrishnan Anjaneyan ◽  
...  
Keyword(s):  
Skin Biopsy ◽  
Index Case ◽  
Direct Immunofluorescence ◽  
Pemphigus Foliaceus ◽  
Pathological Features ◽  
Immunofluorescence Test ◽  
Diagnostic Dilemma ◽  
Histopathological Features ◽  
Exfoliative Dermatitis ◽  
Mucosal Lesions

A 49-year-old male presented with erythroderma of 3-month duration with a flexural onset. No mucosal lesions were present, and skin biopsy showed features of acantholysis and suprabasal clefting. Direct immunofluorescence test was negative in repeated examinations. The patient was presumptively managed as pemphigus foliaceus with immunomodulators though the level of split was suprabasal rather than subcorneal, and the patient responded well to the treatment. However, his elder sister presented to the department with clinical and histopathological features of classical Hailey–Hailey disease (HHD) which resembled the pathological features found in the index case. This prompted us to review the diagnosis and retrospectively diagnose the index case as HHD presenting with erythroderma.

scholarly journals SEEING SKIN IN CUTANEOUS VASCULITIDES THROUGH PATHOLOGIST'S EYES: ROLE OF HISTOPATHOLOGY AND DIF IN DIAGNOSIS

2020 ◽  
pp. 1-3
Author(s):  
Singh Deeksha ◽  
Agarwal Shilpi ◽  
Chander Ram ◽  
Agarwal Kiran ◽  
Singh Preksha
Keyword(s):  
Skin Biopsy ◽  
Vessel Wall ◽  
Cutaneous Vasculitis ◽  
Direct Immunofluorescence ◽  
Clinical Correlation ◽  
Histopathologic Study ◽  
Pathologic Diagnosis ◽  
Skin Manifestations

Vasculitides is a group of disorders characterized by inflammation of vessel wall. Because of its rich vasculature, the skin manifestations are frequently seen in vasculitis. Vasculitis is a clinico-pathologic diagnosis. Histopathologic study of skin biopsy is confirmatory while direct immuofluorescence (DIF) examination is adjunctive to this and helps to categorize the vasculitis. Although the percentages of cases of Cutaneous Vasculitis diagnosed on histopathology & direct immunofluorescence separately were found to be comparable in this study, both techniques have their own place in the confirmation & classification of cutaneous vasculitis particularly in HSP with appropriate clinical correlation.

scholarly journals Direct immunofluorescence of skin biopsy: Perspective of an immunopathologist

2010 ◽  
Vol 76 (2) ◽  
pp. 150 ◽  
Author(s):  
Seema Chhabra ◽  
S Singh ◽  
BD Radotra ◽  
Bhushan Kumar ◽  
RanjanaWalker Minz
Keyword(s):  
Skin Biopsy ◽  
Direct Immunofluorescence

scholarly journals Direct immunofluorescence microscopy of skin biopsy samples preserved in honey

2017 ◽  
Vol 76 (4) ◽  
pp. 761-763 ◽  
Author(s):  
Raghavendra Rao ◽  
Anuradha Jindal ◽  
Balbir Bhogal ◽  
Sathish B. Pai
Keyword(s):  
Skin Biopsy ◽  
Immunofluorescence Microscopy ◽  
Direct Immunofluorescence

Bullous Scabies: Clinical, Dermoscopic, and Pathologic Characteristics of 10 Patients

2021 ◽  
Author(s):  
Feng-Zeng Li ◽  
Meng Jia ◽  
Ke-Jun Chen ◽  
Qian Ye ◽  
Sheng Fang
Keyword(s):  
Differential Diagnosis ◽  
Basement Membrane ◽  
Skin Biopsy ◽  
Poor Response ◽  
Neutrophil Infiltration ◽  
Basement Membrane Zone ◽  
Direct Immunofluorescence ◽  
Skin Scraping ◽  
Pathological Characteristics ◽  
Clinical Variant

Bullous scabies (BS) is a rare atypical clinical variant of scabies and is easily confused with bullous disorders. The diagnosis of BS is always a challenge, and physicians often misdiagnose BS patients. Patients with BS admitted from 2012 to 2020 were enrolled in this study. The clinical, dermoscopic, and pathological characteristics of the patients were analyzed retrospectively. Ten patients with BS were enrolled in this study. Seven of the 10 patients were male. The bullae were most commonly found on the thighs and arms (80% of patients). Only 30% of patients (3/10) tested positive for mites and/or eggs by the initial skin scraping, but 100% (5/5) of the patients who received dermoscopy tested positive. Among these 10 patients, only five received a skin biopsy. Subepidermal (4/5) and intraepidermal (1/5) bullae with eosinophil and neutrophil infiltration were observed in five patients. Direct immunofluorescence (DIF) indicated linear deposition of IgG in the basement membrane zone in three patients. Physicians should consider the possibility of BS in patients with blisters, pruritus, and poor response to corticosteroids. Dermoscopy should be prioritized for the differential diagnosis of BS to exclude other bullous disorders. Finally, a biopsy should be performed on each patient with bullae.

Biopsy Location for Direct Immunofluorescence in Patients with Suspected Bullous Pemphigoid Impacts Probability of a Positive Test Result

2014 ◽  
Vol 18 (6) ◽  
pp. 392-396 ◽  
Author(s):  
Chris Sladden ◽  
Mark G. Kirchhof ◽  
Richard I. Crawford
Keyword(s):  
Skin Biopsy ◽  
Bullous Pemphigoid ◽  
Chart Review ◽  
Normal Skin ◽  
Retrospective Chart Review ◽  
Direct Immunofluorescence ◽  
Positive Test Result ◽  
Complement Proteins ◽  
Biopsy Site ◽  
Test Result

Background: Bullous pemphigoid (BP) is an autoimmune polymorphic skin disease characterized by erythematous papules and plaques and tense bullae. A skin biopsy for direct immunofluorescence (DIF) is used to detect autoantibodies and complement proteins. Objective: We sought to determine which location would provide the highest probability of obtaining a positive DIF result. Method: We undertook a retrospective chart review of 1,423 DIF biopsies. Biopsies with a clinical suspicion of BP were designated as either lesional, perilesional, or indeterminate. Results: Fifty percent of lesional DIF biopsies were positive, whereas 22% of perilesional and 12% of indeterminate biopsies had a positive DIF result. The odds ratio of a positive DIF from a lesional versus perilesional biopsy site was found to be 3.45 (95% CI 1.44–8.29). Conclusion: Clinicians are more likely to obtain a positive DIF result from a lesional nonbullous skin biopsy than from a perilesional or normal skin biopsy.

Eosinophilic vasculitis: an inhabitual and resistant manifestation of a vasculitis

VASA ◽  
2010 ◽  
Vol 39 (4) ◽  
pp. 344-348 ◽  
Author(s):  
Jandus ◽  
Bianda ◽  
Alerci ◽  
Gallino ◽  
Marone
Keyword(s):  
Skin Biopsy ◽  
Intravenous Iron ◽  
Small Vessel Vasculitis ◽  
High Dose ◽  
Raynaud Phenomenon ◽  
The Third ◽  
Left Elbow ◽  
Right Hand ◽  
The Right ◽  
Trunk Skin

A 55-year-old woman was referred because of diffuse pruritic erythematous lesions and an ischemic process of the third finger of her right hand. She was known to have anaemia secondary to hypermenorrhea. She presented six months before admission with a cutaneous infiltration on the left cubital cavity after a paravenous leakage of intravenous iron substitution. She then reported a progressive pruritic erythematous swelling of her left arm and lower extremities and trunk. Skin biopsy of a lesion on the right leg revealed a fibrillar, small-vessel vasculitis containing many eosinophils.Two months later she reported Raynaud symptoms in both hands, with a persistent violaceous coloration of the skin and cold sensation of her third digit of the right hand. A round 1.5 cm well-delimited swelling on the medial site of the left elbow was noted. The third digit of her right hand was cold and of violet colour. Eosinophilia (19 % of total leucocytes) was present. Doppler-duplex arterial examination of the upper extremities showed an occlusion of the cubital artery down to the palmar arcade on the right arm. Selective angiography of the right subclavian and brachial arteries showed diffuse alteration of the blood flow in the cubital artery and hand, with fine collateral circulation in the carpal region. Neither secondary causes of hypereosinophilia nor a myeloproliferative process was found. Considering the skin biopsy results and having excluded other causes of eosinophilia, we assumed the diagnosis of an eosinophilic vasculitis. Treatment with tacrolimus and high dose steroids was started, the latter tapered within 12 months and then stopped, but a dramatic flare-up of the vasculitis with Raynaud phenomenon occurred. A new immunosupressive approach with steroids and methotrexate was then introduced. This case of aggressive eosinophilic vasculitis is difficult to classify into the usual forms of vasculitis and constitutes a therapeutic challenge given the resistance to current immunosuppressive regimens.

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