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A5.19 Usefulness of punch biopsy in cutaneous lesions with autoimmune profile in rheumatology
  1. LM Jimenez Liñan,
  2. JA Paz Solarte,
  3. ML Velloso Feijoo,
  4. JL Marenco de la Fuente
  1. Rheumatology Unit, Valme University Hospital, Sevilla, Spain

Abstract

Background and objectives Many autoimmune inflammatory rheumatic diseases have typical cutaneous manifestations, but not always macroscopic skin lesions are characteristic, so it is necessary to perform a skin biopsy to identify a specific pattern that help us to confirm our suspected diagnosis and make a better treatment decision.

Materials and methods Descriptive study about 20 patients with skin lesions evaluated in our Rheumatology Unit in the last 18 months, which underwent a skin punch biopsy, as part of the supplementary studies.

Results The mean age was 48.9 years ± 20.25 and 90% were women. Only 4 of the 20 patients (20%) had autoimmune diseases (3 hypothyroidism and 1 seronegative oligoarthritis); 11 had cardiovascular risk factors (3 arterial hypertension, 4 dyslipidemia, 3 had type 2 diabetes and 3 had obesity); and 3 had endocrine disorders (1 microprolactinoma, 1 anorexia nervosa and 1 with secondary hyperparathyroidism).

Five patients (25%) had fever, 4 patients (20%) oligoarthritis, 1 patient had pneumonia and 1 patient Raynaud’s phenomenon.

The only 2 patients with positive ANA, both women, had inmunoglobulins alterations. One of them presented leukocytoclastic vasculitis (LCV) with hypergammglobulinemia IgA and IgM and positive test for rheumatoid factor (RF), and the other had unspecific cutaneous lesions with hyper-IgA. Another patient had hyper-IgE, related to eosinophilic dermatitis.

The results of the biopsies were the following (see the table 1 below):

Abstract A5.19 Table 1

The pathology findings of the biopsies and the number of people with percentage who present that diagnosis in our serie

Ninety percent were treated with systemic corticosteroids. One patient received nonsteroidal anti-inflammatory drug (NSAID), 1 alprostadil (hypertensive ulcer), 2 sodium thiosulfate (calciphylaxis) and 2 disease modifying antirheumatic drugs (DMARDs) (mixed panniculitis related to intestinal bypass and LCV complicated by ulcers). Ninety percent had an excelent prognosis and only 2 had a poor response to corticosteroids and required intravenous cyclophosphamide (1 calciphylaxis and the LCV complicated).

Conclusions In our opinion, the skin punch biopsy is essential in the rheumatologic clinical practice. This is a very simple and easy procedure with a low rate of complications and, although the results are sometimes unspecific, we can improve the diagnosis if the rheumatologist provides clinical information to the pathologist.

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