Vimentin compartmentalization in discoid lupus.

CONTEXT: Discoid lupus erythematosus (DLE) is a chronic skin condition, often presenting inflammatory, scarring lesions predominating on sun exposed areas of the face and scalp.

CASE REPORT: A 46-year-old black female was evaluated for possible DLE. Biopsies for hematoxylin and eosin (H&E) and immunohistochemistry (IHC) examination, as well as for direct immunofluorescence (DIF) analysis were performed. The H&E staining demonstrated mild epidermal atrophy with focal follicular plugging. A mild interface infiltrate of lymphocytes and histiocytes and a superficial and deep, perivascular and periadnexal dermal infiltrate of lymphocytes, histiocytes and plasma cells was observed The DIF revealed strong deposits of immunoglobulins IgG, IgM, fibrinogen and Complement/C3, present in a granular pattern at the basement membrane junction (BMZ) of the skin as well as in the BMZ of the sebaceous glands. In addition, deposits of IgA surrounding the superficial dermal blood vessels were appreciated. The IHC displayed compartmentalization of vimentin around the BMZ of both the superrficial skin and sebaceous gland BMZs, as well as similar patterns of deposits of the same immunoglobulins, complement, and fibrinogen as visualized by DIF.

CONCLUSIONS

Minimal attention has been given to the process of compartmentalization of the dermis in inflammatory skin conditions, including DLE. However, it seems that in addition to the classical immunoglobulin and complement "lupus band" deposits at the BMZ, an additional, orchestrated immunologic reorganization of the dermis surrounding the inflammatory process is also present. Such an immunologic reorganization of the dermis could play a significant role in the pathophysiology of this disorder.