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Erythema elevatum diutinum

II. Immunelektronenmikroskopische Untersuchung der leukocytoklastischen Vaskulitis in einer Intrakutanreaktion mit Streptokokkenantigen

Erythema elevatum diutinum

II. Immunoelectronmicroscopical study of leukocytoclastic vasculitis within the intracutaneous test reaction induced by streptococcal antigen

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Summary

A leukocytoclastic vasculitis was induced by intracutaneous injection of streptococcal antigen in a patient with erythema elevatum diutinum (E.e.d.). The immunoelectronmicroscopical demonstration of C3 was performed by use of the peroxidase-antiperoxidase multistep technique 24 h after the injection of the antigen.

Deposits of C3 were found between endothelial cells, on the outer surface of endothelial cells, pericytes, and smooth muscle cells, as well as within the multilayered basal lamina of small vessels. Intact and disintegrating neutrophils accumulate within the vessel walls and in their surroundings. Necrosis and fibrin deposition are present in advanced stages.

The findings demonstrate the sequence of events in leukocytoclastic vasculitis at the ultrastructural level. They also support the hypothesis that in E.e.d. an Arthus type reaction induced by bacterial antigens may be of pathogenetic significance.

Zusammenfassung

Eine leukocytoklastische Vaskulitis wurde durch intrakutane Injektion von Streptokokkenantigen bei einer Patientin mit Erythema elevatum diutinum (E.e.d.) ausgelöst. Der immunelektronenmikroskopische Nachweis von C3 in dieser Reaktion wurde 24 h nach der Injektion der Antigens mit Hilfe der Peroxydase-Antiperoxydase-Mehrstufentechnik durchgeführt.

C3-Niederschläge fanden sich in der Intercellularfuge zwischen Endothelzellen, Pericyten und glatten Muskelzellen und der aufliegenden Basallamina sowie zwischen den Duplikaturen der mehrschichtigen Basallamina kleiner Gefäße. Intakte und zerfallende Neutrophile durchsetzen die Gefäßwände und die Gefäßumgebung. Es resultieren Nekrose und Fibrinablagerung.

Die Befunde zeigen die Sequenz der Ereignisse bei leukocytoklastischer Vaskulitis auf dem ultrastrukturellen Niveau und stützen gleichzeitig die Hypothese, daß eine durch Bakterienantigen ausgelöste Reaktion vom Arthus-Typ bei E.e.d. pathogenetisch bedeutsam ist.

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Authors and Affiliations

  1. Dermatologische Klinik und Poliklinik der Universität München, Frauenlobstr. 9-11, D-8000, Müchen 2

    Helmut H. Wolff, Wojciech Maciejewski & Otto Braun-Falco (Direktor)

  2. Abt. Experimentelle Medizin, Max-Planck-Institut für Biochemie, Martinsried bei München, Bundesrepublik Deutschland

    Reiner Scherer

Authors
  1. Helmut H. Wolff
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  2. Reiner Scherer
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  3. Wojciech Maciejewski
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  4. Otto Braun-Falco
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Mit Unterstützung durch die Deutsche Forschungsgemeinschaft. Fräulein E. Januschke sei für selbsttätige technische Mitarbeit herzlich gedankt

Stipendiat der Alexander-von-Humboldt-Stiftung aus Warschau/Polen

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Wolff, H.H., Scherer, R., Maciejewski, W. et al. Erythema elevatum diutinum. Arch Dermatol Res 261, 17–26 (1978). https://doi.org/10.1007/BF00455371

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  • DOI: https://doi.org/10.1007/BF00455371

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