Evaluation of the relation between T-Lymphocytes (CD4 + ve and CD8 + ve) and pemphigus vulgaris pathogenesis and severity

Abstract

Background: Pemphigus vulgaris (PV) is an autoimmune bullous disease involving both the skin and mucus membranes. Infiltrating CD4+ and CD8+ T-lymphocytes may have a vital role in its pathogenesis. The autoimmune bullous skin disorder intensity score (ABSIS) was proposed for clinical evaluation and scoring of PV patients. Aims and Objectives: This work aimed to assess the role of CD4+ and CD8+ T-lymphocytes in the pathogenesis of PV and the correlation between number of T-lymphocytes infiltrate and clinical severity of the disease evaluated by ABSIS. Patients and Methods: Forty PV patients (patient group) and 10 healthy volunteers (control group) were enrolled. All patients were scored by ABSIS. Immunohistochemical staining was performed on skin biopsies for IgG, IgA, CD8, and CD4. Results: IgG was positive in 97.5% of patients, combined IgG and IgA were positive in 20% of patients, and only one case was negative for both antibodies. Thirty-three cases showed the predominance of CD4+ T cells, and seven cases showed predominance of CD8+ T cells. CD4/CD8 ratio was 2.578. Non-significant positive correlation was found between the total count of lymphocytic infiltrate and ABSIS. Conclusion: CD4+ and CD8+ T-lymphocytes share in the pathogenesis of PV and CD4+ are more expressed than CD8+ in the inflammatory infiltrate of PV lesions. The correlation between total lymphocytic count and ABSIS score may help to predict the clinical state of the patient from skin biopsy, and ABSIS score can predict the lymphocytic infiltration in PV cases. This correlation is in need to be reapplied on larger scales of patients to confirm its validity and reliability.