UPMC Dermatopathology

UPMC Dermatopathology "Case of the Month" Presentations

UPP - Department of Dermatology, Dermatopathology Unit

5230 Centre Avenue (412) 623-2614          Pittsburgh, PA 15232 (412) 682-6450 FAX


Holly R. Mason, M.D., Ph.D., Rana Rofagha, M.D., Drazen M. Jukic, M.D., Ph.D.

MARCH 2007 CASE OF THE MONTH


CLINICAL FINDINGS

Clinical History

33 year old white male presented with a one year history of blisters beginning on the scalp that progressed to involve the chest, back, neck, and arms.   He described the blisters as pruritic and painful when ruptured. 

His past medical history included obstructive sleep apnea and asthma; his medications included albuterol PRN and montelukast. 

Physical Exam

On exam, multiple vesicles as well as erythematous papules and plaques with overlying scale and crust were noted on the scalp, chest, back, and arms (Figures 1-3).

Histopathology:

A punch biopsy was taken from one of the lesions on the back and demonstrated a subcorneal split with pronounced acantholysis and evidence of spongiosis (Figures 4-7).  Evaluation of immunofluorescence revealed an intercellular pattern of IgG deposits (Figure 8). 

Figures & Images

Figures 1-3. Multiple vesicles, erythematous papules and plaques with overlying scale-crust on the back.

Figures 4-7 (H+E), Subcorneal split with acantholysis and evidence of spongiosis.
  • Figure 4, 4X
  • Figures 5-6, 10X
  • Figure 7, 20X

  • Figure 8 (DIF), Intercellular IgG deposits.

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