02403nas a2200325   4500000000100000008004100001260001300042653001500055653002600070653002900096653001200125653002100137653002900158653001100187653002000198653001200218653002500230653002500255100001700280700001400297700001400311700001300325700001600338700001100354245012800365300001000493490000700503520155300510022001402063       1992                            d  c1992 Jun10aAntibodies10aAntibodies, Bacterial10aAntigen-Antibody Complex10aBlister10aErythema Nodosum10aExudates and Transudates10aHumans10aImmunoglobulins10aleprosy10aLeprosy, lepromatous10aMycobacterium leprae1 aScollard D M1 aBhoopat L1 aKestens L1 aVanham G1 aDouglas J T1 aMoad J00aImmune complexes and antibody levels in blisters over human leprosy skin lesions with or without erythema nodosum leprosum.  a230-60 v633 a<p>Erythema nodosum leprosum (ENL) is a serious complication of lepromatous leprosy, affecting skin and peripheral nerves in a large percentage of these patients, and is presumed to result from spontaneous immunologic changes. Its pathogenesis is poorly understood, although histopathologic features have suggested immune complex (IC)-mediated injury. Abundant circulating antibody is present but no convincing correlation has been established between circulating IC and ENL. We have examined cutaneous leprosy lesions in vivo using blisters induced by prolonged gentle suction to determine whether or not IC are demonstrable in lesions with or without ENL, using an IC assay based on monoclonal rheumatoid factor binding. We also examined whether antibodies involved in such IC are produced locally or reach the skin via the circulation. Surprisingly large quantities of IC were found in ENL lesions, and in some cases the quantities were significantly higher than in matching serum. Total IgG, IgA, and IgM in the skin were not higher than expected, however. Attempts to demonstrate increases in intracutaneous levels of specific anti-Mycobacterium leprae antibodies were unsuccessful. This is the first report of the demonstration of IC in suction blister fluid. The results indicate that large quantities of IC may be present in cutaneous leprosy lesions and are consistent with the hypothesis that they are formed in situ when circulating antibody combines with antigen in the skin. The nature of the antigen in these IC remains undefined.</p>  a0090-1229