P 137 Direct immunoelectron microscopy on uninvolved conjunctiva for the diagnosis of autoimmune bullous dermatosis

Parpose: Direct immunofluorescence (DIF) study on the conjunctiva is currently the classical diagnostic tool used fo the. diagnosis of autoimmune cicatrizing conjunctivitis, which is characterized by the deposition of immunoglobuliis and/or compleme:nt along the conjunctival basement membrane zone (BMZ). To diagnose the type of autoimmune conjunctivitis, we performed d&t immunoeleclron microscopy (DIEM) on the conjunctiva. Methods: Three patients presentmg with cicatrizing conjunctivitis associated with auto-immune bullous dermatosis and/or mucous membrane blistering lesions underwent conjunctival and cutaneous or mucoos membrane biopsies for DIF and DIEM. Resuk DIF was positive in 2 cases and DIEM was wsitive in the three cases. According io the dermatoloI~ca1 DIEM criteha for autoimmune bullous diseases, three different pauems of immune deposition along the BMZ were seen using DIEM. One pattern was highly consistent with cicaaicial pcmphigoid, the second with bullous pemphigoid and the last one with epidermolysis bollosa acquisita respectively, P137 TITLE: DIRECT IMMUNOELECTRON MICROSCOPY ON UNINVOLVED CONJUNCTIVA FOR THE DIAGNOSIS OF AUTOIMMUNE BULLOUS DRRMATOSIS. Purpose: Conjunctival involvemen is not always present in autoimmune bullous dermatosis (ABD). We report on hvo patienm with skin blisters, who underwent conjunctival biopsies. althoughno conjunctival inflammation nor fibrosis was detectable. Methods: The following studies were performed: direct immuno-fluorescence (DIF) on the skin and Ihe coniunctiva. direct immunoelecaon micmscopy @IEM) on the skin and the corijunctiv~ indirect IF and western immunoblotting on epidermrd and dermal extracts. Resulls: Immunomorphologic examination of the normal conjunctiva nvealed immune deposits on tbe basement membrane zone (BMz). Using DIEM these deposits had the same localization within the BMZ of both the skin and the conjunctiva. According to the derma~logical classification of ABD, the pattern of immune deposition was consistent with the diagnosis of bullous pemphigoid in one patient and cicatricial pemphigoid in the other. Condusions: Immune deposits can be seen on normal conjunctiva if associated with ABD. DIEM on the conjunctiva, even uninvolved, can be helpful for the diagnosis of ABD. Backaround: Conjunctival papilloma is a finger-like proliferation of conjunctival tissue The evolution is benign in the vast majority of cases, but malignant evolution can rarely occur. The disease is classically attributed to Human Papilloma Virus (HPV). This virus may also infect other epithelia, especially~genital surfaces. Submitting tissues for the detectlon of HPV may have clinical implications Material and methods: A 23.year old patient was evaluated in 1994 for a conjunctival lesion in the lefl internal canthus Clinical examination was normal, except an exophytic and slowly …