ROLE OF DIRECT IMMUNOFLUORESCENCE ON TZANCK SMEAR IN PEMPHIGUS VULGARIS
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2019, Vol 8, Issue 4
Abstract
BACKGROUND The Tzanck smear is a simple, sensitive, and rapid test to diagnose pemphigus vulgaris (PV), a life-threatening autoimmune blistering disorder. The presence of acantholytic cells in cytology is indicative of, but not specific for PV. Hence, a direct Immunofluorescence (DIF) test to demonstrate immunoglobulin deposits on the acantholytic cells would make the Tzanck test more specific, and rapid. The DIF smears were compared with DIF on skin biopsies in the same patient to evaluate the diagnostic efficacy. Aims and Objectives-To study the expression of IgG and C3 in cytology of pemphigus vulgaris using Tzanck smears and to compare direct immunofluorescence in Tzanck smears with corresponding perilesional skin biopsies. MATERIALS AND METHODS Study Design- Diagnostic test evaluation. Study Population- Study was performed on oral scrape smears procured from clinically diagnosed cases of pemphigus vulgaris attending the dermatology department during the study period. (March 2017-August 2018). Sample Size- 30. Sampling Procedure- Continuous sampling. Study Procedure- DIF for IgG and C3 done on both Tzanck smears and corresponding perilesional skin biopsies. Analysis-Sensitivity, specificity, positive predictive value and negative predictive value was used to compare immunofluorescence in Tzanck smears with skin biopsies. Non-parametric test (Kendall’s tau-b) was used to assess correlation. RESULTS Age group of study population ranges from 14 to 74 years with mean age being 49 years. IgG was positive in 80% of Tzanck smears and 83% of skin biopsies. C3 was positive in 60% of Tzanck smears and 70% of skin biopsies. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of Tzanck smears in the investigation of IgG were (%) 92, 80, 95, and 66; and C3 were (%) 76, 77, 88, 58. The correlation coefficient between Tzanck smears and corresponding skin biopsies for IgG and C3 were 0.670 and 0.505 respectively. CONCLUSION There is definite correlation between IgG and C3 staining in Tzanck smears compared to skin biopsy with a correlation coefficient of 0.670 and 0.505 respectively. So DIF on Tzanck smears can be used for presumptive diagnosis of pemphigus vulgaris which avoids the need for biopsy and delay in starting therapy.
Authors and Affiliations
Arun Jose, Sheeja S, Mary Vineetha, Sankar S
Keywords
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- EP ID EP553783
- DOI 10.14260/jemds/2019/55
- Views 98
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