The correlation between cutaneous IgM deposition and renal involvement in adult patients with Henoch-Schönlein purpura

Abstract

Background: Henoch-Schönlein purpura (HSP) is a systemic and immune complex-related leukocytoclastic vasculitis. A positive correlation has been found between IgM deposition along with IgA in skin lesions diagnosed by direct immunofluorescence (DIF) and renal involvement with HSP. Objectives: We sought to investigate the relationship between the systemic associations of the disease and the severity of the skin lesions, as well as the immune deposition findings of the lesional skin provided by DIF in patients with HSP. Materials & Methods: Between 2001 and 2012, 47 patients with HSP were investigated at our dermatology clinic. Epidemiologic data, laboratory findings, localizations of the palpable purpura, existence of bulla or necrosis in the skin lesions, accompanying systemic involvement, and DIF findings of skin biopsy specimens were recorded. Results: Of the 47 patients 22 were men and 25 were women (age range 16-88 years, mean 42.2). Among all cases with skin involvement, we found 22 (46.8%) articular involvement, 20 (42.6%) renal involvement and 12 (25.5%) gastrointestinal tract involvement. The frequency of bulla and/or necrosis in the skin lesions was significantly high in patients with gastrointestinal and renal involvement (p<0.05). The risk of renal involvement was significantly high in patients whose DIF examination revealed IgM deposition (p<0.05). No association was found between systemic involvement and IgG, complement 3 (C3) and fibrinogen deposition. Conclusion: Patients with HSP, having bullous and/or necrotic lesions and whose skin DIF investigations reveal IgM deposition along with IgA, should be surveyed for the risk of renal involvement.

Bullous Skin Lesions in an Adult Male: A Diagnostic Dilemma

“…Both the absence of these co-existing diseases and the lower rate of deep-organ involvement seem to indicate a better prognosis. This conflicts with a recent report by Belli et al, who in their description of 47 Turkish patients found a significant relationship between frequency of bullous and necrotic lesions and the development of gastrointestinal and renal involvement in HSP [15]. They also note an association with IgM and renal involvement, although Poterucha et al have previously argued against such a relationship in their cohort [12].…”

Direct immunofluorescence testing in vasculitis—A single institution experience with Henoch‐Schönlein purpura

“…Similarly, Barnadas et al found IgA to be the most frequently detected immunoglobulin in LCV patients overall, and showed its association with renal involvement . Nevertheless, in 2 previously reported studies, IgM deposition was found to be associated with a higher risk of renal involvement, primarily in adult patients; however, these findings were not reproducible in children . Importantly, in this study, the presence of immunoreactants other than IgA in the setting of histologically confirmed LCV did not seem to predict systemic or persistent disease, although the number of cases with IgG or IgM immunoreactivity was low.…”

“…Similarly, Barnadas et al found IgA to be the most frequently detected immunoglobulin in LCV patients overall, and showed its association with renal involvement. 6 Nevertheless, in 2 previously reported studies, IgM deposition was found to be associated with a higher risk of renal involvement, primarily in adult patients 12,13 ; however, these findings were not reproducible in children. 14 (14), vaso-occlusive (14), PPD (9), non-inflammatory purpura (6), interface dermatitis (5), neutrophilic dermatosis (4), cryoglobulinemia (1), EN (1), LV (1) and MVV (1).…”

Biomarkers of IgA vasculitis nephritis in children

“…Moreover, other groups have studied the presence of immunoglobulins in organ deposits. IgM has been associated with IgA skin deposits in children [ 17 ] and nephritis in adults [ 18 – 20 ]. IgG deposition in the kidney was associated with the nephritis outcome in adult IgAV patients [ 20 ].…”