CHRONIC ULCERATIVE STOMATITIS WITH STRATIFIED EPITHELIUM-SPECIFIC ANTINUCLEAR ANTIBODIES

Background. In 1990 a new disease-associated antinuclear antibody was first recognized as a specific immunologic marker for a chronic form o f ulcerative stomatitis (CUS). Methods. Another case is reported herei n and the subject of chronic ulcerative stomatitis with stratified epi thelium-specific antinuclear antibodies (SES-ANA) is reviewed, Intraor al biopsies from this patient were submitted for microscopic examinati on and direct immunofluorescence. Indirect immunofluorescence studies were also performed. Serial SES-ANA liters were obtained with the pati ent on maintenance treatment with hydroxychloroquine. A skin biopsy of a recent lichenoid eruption was obtained and skin explants grown in t he serum of this patient were studied in tissue culture with reference to SES-ANA binding and complement fixation. Results. Biopsy and serum studies confirmed a diagnosis of CUS with SES-ANA in the patient repo rted. Skin biopsy showed lichen planus. The patient was treated with h ydroxychloroquine with a favorable response. Serial SES-ANA titers did not parallel the disease activity. Among the substantive observations made from skin explants cultured in the serum of this patient was wid espread fixation of C3 to the nuclei of basal cells. Conclusions. The case described herein extends the findings in CUS to include lichenoid skin lesions. Records show that at least four of 11 cases of CUS had skin lesions, whereas all had oral lesions. Stratified epithelium-spec ific antinuclear antibodies serve as the key marker of CUS. Skin expla nts grown in the serum of this CUS patient bind SES-ANA in tissue cult ure. Sections of explants fix complement. Titers of SES-ANA ANA have b een reported to parallel disease activity in one case, but not in the present case. Thus, there appears to be case-to-case variation. The tr eatment of choice for CUS is hydroxychloroquine.