Clinicopathological Significance of Oral Mucosal Epithelial Cell Staining for IgG, IgA, and IgM by Direct Immunofluorescence
Alshagroud, Rana Saud
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While anti-nuclear autoantibody (ANA) speckled staining of oral epithelial cells in direct immunofluorescence (DIF) is characteristic of chronic ulcerative stomatitis (CUS), it is currently unknown whether ANA staining of oral biopsies is also indicative of other autoimmune diseases. The ANA staining patterns under DIF present in oral epithelium and the correlation to H&E findings are poorly understood. We hypothesized that ANA positivity in oral epithelium may be an adjunctive diagnostic marker of systemic connective tissue diseases. We performed a retrospective study to describe the pattern of in vivo ANA in oral epithelium, to correlate the pattern with H&E findings, and determine whether patients with these findings had a co-existing systemic connective tissue disease. We examined 72 cases from our laboratory collected between 2013 and 2016 that showed ANA staining on DIF of oral biopsies. Immunoglobulin G (IgG) was the most common immunoreactant antibody class (71/72 cases), while speckled nuclear staining was the most common in vivo ANA pattern (52/72). Thirty-four cases had H&E biopsies and most were diagnosed as non-specific chronic mucositis (13/34) or interface mucositis (11/34). Submitting clinicians were informed that the patients need evaluation for autoimmune disease. The clinicians were contacted to determine what follow-up was carried out. We obtained clinical information for 10 cases. These cases had a diagnosis of autoimmune diseases included rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, and CUS. Based on our findings, we recommend that patients who show in vivo ANA deposits in oral mucosal biopsies should be investigated for the presence of or to rule out any systemic autoimmune disease.