Comparison of Direct Immunofluorescence and Desmoglein Elisa 1 and 3 in Pemphigus Vulgaris Patients in Clinical Remission

Anjali, V T (2020) Comparison of Direct Immunofluorescence and Desmoglein Elisa 1 and 3 in Pemphigus Vulgaris Patients in Clinical Remission. Masters thesis, PSG Institute of Medical Sciences and Research, Coimbatore.


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BACKGROUND: Pemphigus vulgaris patients in clinical remission either suffer from risk ofrelapse due to early withdrawal of treatment or from side effects of steroids due to prolonged course of treatment. The most challenging decision we face in the management of pemphigus is the decision regarding when to stop the treatment. Comparative studies between DIF and desmoglein ELISA in evaluation of immunological remission is not available in India and hence we are conducting this study. AIM OF THE STUDY: To compare DIF and Desmoglein 1 and 3 ELISA in evaluation of immunological remission. METHODOLOGY: 30 biopsy and DIF proven cases of pemphigus vulgaris in 6 months clinical remission defined as no new or non healing skin or mucosal lesions for past 6 months or more and receiving less than or equal to 10 mg prednisolone with or without low dose immunosuppressive therapy such as azathioprine 50 mg or cyclophosphamide 50 mg daily were taken. Direct Immunofluorescence and Desmoglein ELISA were done. Intercellulardeposits ofIgG and/or C3 were considered positive in DIF and index value of > 20.0 was considered positive in ELISA test. Sensitivity, specificity, PPV and NPV of DsgELISA were assessed by taking DIF as gold standard in assessment of immunological remission. RESULTS: DIF and anti-Dsg (1 or 3) ELISA were positive for 21 (70 %) and 20 patients (66.7 %), respectively. Anti-Dsg ELISA had a sensitivity of 85.7%, a specificity of 77.8%, a positive predictive value of 90% and a negative predictive value of 70%. CONCLUSIONS: The high sensitivity of anti-DsgELISA proves that this simple serological test is a good substitute for DIF for evaluation of immunological remission in Pemphigus vulgaris patients. Another advantage of ELISA is that large number of samples can be processed at same time and it doesn’t require the technical expertise of a pathologist. Our study also concluded that patients in clinical remission are not in immunological remission and hence it is better to do these test before stopping the drugs based on clinical remission, inorder to reduce the risk of relapse in future.

Item Type: Thesis (Masters)
Additional Information: 201730351
Uncontrolled Keywords: desmoglein enzyme linked immunosorbentassay, direct immuno fluorescence, pemphigus vulgaris.
Subjects: MEDICAL > Dermatology Venereology and Leprosy
Depositing User: Subramani R
Date Deposited: 05 Feb 2021 15:38
Last Modified: 05 Feb 2021 15:38

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