Cutaneous immunofluorescence studies in bowel bypass syndrome

Five patients that developed a multisystem disease after bowel bypass surgery for the treatment of obesity were studied. Patients developed a non-pruritic papular eruption following bypass surgery. Immunofluorescence studies were done on (1) an early skin lesion, (2) from uninvolved sun-exposed skin from the dorsum of left wrist, and (3) uninvolved non-sun-exposed skin from the buttock. Deposition of immunoglobulin (Ig) and/or complement (C) was seen along the dermoepidermal (DE) junction in the skin from the early lesions and uninvolved sun-exposed skin in all five patients. No deposition of Ig and/or C was seen along the DE junction in uninvolved non-sun-exposed skin or in the blood vessels of any of the sections studied. Later, in all five patients, the bowel was restored to normal continuity. In repeat biopsies of the same sites the earlier observations were no longer present. This study indicates that DE junction deposition of Ig and/or C is a dynamic process, and supports the hypothesis that immune mechanisms may play an important role in the pathogenesis of bowel bypass syndrome.