Immunobullous Disorder: A Diagnostic Dilemma Faced at a Tertiary Care Centre in Kanyakumari, Tamil Nadu, India

Abstract

Introduction: Immunobullous disorders are morphologically heterogenous and hence the differentiation between various subtypes is essential for proper treatment and prognosis. Prompt diagnosis needs clinicopathological concordance added with Immunofluorescence (IF) in particular Direct Immunofluorescence (DIF) study to avoid discrepancies. Aim: To study the clinicopathological profile along with immunological features and to analyse the utility of IF in particular DIF of immunobullous disorders. Materials and Methods: The present study was a single institution based cross-sectional observational hospital study done in the department of pathology in SreeMookambika Institute of Medical Sciences, Tamil Nadu over a period of one year (July 2019-August 2020) involving 70 outpatients in the department of dermatology with clinical evidence of bullous disorders. Two biopsies were taken from the patient, one from a newly formed bulla or vesicle for Haematoxylin and Eosin (H&E) stain and the other from a perilesional normal looking skin for DIF study. Statistical analysis was done by using SPSS software. Chi-square test was used for statistical analysis. A p-value of less than 0.05 was considered as statistically significant. However, the final diagnosis was arrived after considering clinical, bedside investigations, histopathology and DIF study. Results: Out of seventy (70) patients included in this study, the most common age group of distribution was between 51-60 years in a frequency of 22 (31.4%). Out of 70 patients, 39 patients were diagnosed with intraepidermal bullous disorders and 31 patients were diagnosed with subepidermal bullous disorders. The most common disorder diagnosed was based on clinical findings was Pemphigus Vulgaris (PV) 31 (44.3%) followed by Bullous Pemphigoid (BP) 23 (32.9%). The common disorder diagnosed based on histopathology was PV 33 (47.1%). Clinical and histopathological concordance was conclusive in 31 cases of PV. The percentage of diagnosis of DIF was positive in 67 (95.71%). Patients which reached to inconclusive (DIF was not definite) diagnosis was in only three patients. Conclusion: Since, in most of the cases there occurs an overlap in clinical and histopathological features, IF in particular, DIF plays a sensitive tool in confirming diagnosis as well as distinguishing immunobullous disorders from other disorders.