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KMID : 0376219960320010049
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Chonnam Medical Journal
1996 Volume.32 No. 1 p.49 ~ p.58
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Histopathological and Immunofluorescence Microscopic findings in Allergic Purpura
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Abstract
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Background:
@EN Allergic purpura is a vasculitis characterized by leukocytoclastic histopathologic finding. It is associated with petechial spots or ecchymosis on the lower extremities and is sometimes accompanied by general symptoms such as arthralgia and
abdominal pain. Although the vascular destruction by an inflammation has been suggested to be mediated by deposition of circulating immunecomplexes secondary to infections, food, drugs, autoimmune disease, ect., the pathomechanism of the allergic
purpura is still unclear.
@ES Method:
@EN To determine the types of deposits of the immunoreactants and to understand pathogenetic mechanism of allergic purpura, direct immunofluorescence tests(DIF) were performed as well as clinical and histopathologic findings were evaluated. Ten
patients
with allergic purpura diagnosed by clinical and histopathological findings and examined by IF test were objected.
@ES Results:
@EN The purpuric skin lesions are located predominantly on the lower extremity. Arthralgia in 6 cases and abdominal pain in 4 were found. Leukocytosis, elevated ESR and ASO, hematuria, proteinuria and occult blood were revealed in laboratory
examinations. The histopathological findings including RBC extrauasation, fibrin deposition, nuclear dust and perivascular inflammatory cell infiltrations were limited mainly to the upper dermis. In early lesions less than 24 hr old, the cellular
infiltration was consisted mainly of neutrophils. In late lesions older than 72 hr, however, the number of neutrophils decreased more and mononuclear cells predominated. In the DIF study, fibrin in 10, C3 in 6, IgA and C4 in 4, IgM in 1 of 10
patients
were found to accumulate mainly on the blood vessels of the upper dermis. Five case of early lesions less than 24 hour-old were associated with the deposition of immunoglobulins, 'particularly IgA' and complement, while 5 cases of late lesions
more
than
72 hour-old were with fibrin only except 1 case.
@ES Conclusion:
@EN This study supports that allergic purpura is caused by vascular destruction by lekocytic infiltration mediated by deposition of immunoglobulins ' particularly IgA' and complement. It is also demonstrated that there are variations in
immunoreactant
and cellular changes observed by DIF test and H-E staining according to the duration of skin lesions.
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KEYWORD
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