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Journal of the American Academy of Dermatology
Volume 7, n° 4
pages 511-520 (octobre 1982)
Doi : 10.1016/S0190-9622(82)70134-3
Bullous systemic lupus erythematosus
 

Alan J. Olansky, M.D. a, Robert A. Briggaman, M.D. a, W. Ray Gammon, M.D. a, Timothy F. Kelly, M.D. a, W. Mitchell Sams Jr., M.D. *
1 From the Department of Dermatology, The University of North Carolina at Chapel Hill School of Medicine. 
* The University of Alabama, Department of Dermatology, University Station, Birmingham, AL. 

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Two patients with established systemic lupus erythematosus developed bullous dermatoses clinically suggestive of bullous pemphigoid (BP). Direct immunofluorescence demonstrated linear staining at the dermoepidermal junction for IgG and C3 in a pattern typical for BP. However, immunoelectron microscopy demonstrated deposits of IgG largely below the basal lamina, with little if any deposit present within the lamina lucida. These findings are consistent with systemic lupus erythematosus (SLE) and effectively rule out BP. In addition, the leukocyte attachment assay, an in vitro assay of the functional activity of tissue-deposited immune complexes, demonstrated strong attachment of leukocytes to the dermoepidermal junction of patients' skin, suggesting that the immune reactants were functional immune complexes of possible importance to the pathogenesis of the bullous lesions. To our knowledge, this is the first time that immunoelectron microscopy has been performed on skin from patients suspected of manifesting concurrent SLE and BP. Our findings cast doubt on previous such reports by demonstrating the existence of a bullous form of SLE resembling BP both clinically and by direct immunofluorescence. (J AM ACAD DERMATOL 7:511-520, 1982.)

The full text of this article is available in PDF format.

 Supported by National Institutes of Health (NIH), National Institute of Arthritis, Metabolism, and Digestive Diseases (NIAMDD), The Epidermal Protein of Photocontact Allergy I R01 AM20031-03 Dermatology Foundation Grant, Studies of an In Vitro Model of Bullous Pemphigoid (NIH, NIAMDD), and The Utilization of Epidermal Cell Model From Human Skin 5 R01 AM 10546-16. Accepted for publication March 5, 1982.

a  Reprint requests to: Dr. Robert A. Briggaman, Department of Dermatology, University of North Carolina School of Medicine, Chapel Hill, NC 27514.

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