UPP - Department of Dermatology, Dermatopathology Unit
Holly R. Mason, MD, PhD, Joseph C. English III, MD, Arash Radfar, MD, PhD
AUGUST 2008 CASE OF THE MONTH
Our dermatology service was consulted to evaluate an otherwise healthy 33 year old male who was in the trauma intensive care unit after sustaining a pelvic fracture. His hospital course was significant for respiratory failure and fever. Per nurse report, the patient had been developing blisters on his abdomen and arms over the past several hours.Â
His past medical history was non-contributory. His medications included Combivent, chlorhexidine, docusate, famotidine, lactulose, lactobacillus, meropenem, nystatin, senna, and vancomycin. Of note, he had also been on cefepime, cefuroxime, metronidazole, and gentamicin during his hospital admission over the prior two weeks.
Vesicles and bullae on axillae, abdomen, and thighs; denuded bullae on flanks and back; no ulcerations, blisters, or erosions of mucosal surfaces (Figures 1-4).
Bullous drug eruption, allergic contact dermatitis, linear IgA bullous dermatosis
Histopathological examination of a biopsy from a blister on the left thigh revealed a neutrophil-rich subepidermal bullous dermatosis (Figure 5-7). Direct immunofluorescence studies demonstrated linear deposition of IgA at the dermo-epidermal junction (Figure 8).
Figures 1-4. Vesicles-bullae on axillae, abdomen, thighs
Figure 5-7. (H+E) Neutrophil-rich subepidermal bullous dermatosis
Figure 8. (DIF) Linear deposition of IgA at the dermo-epidermal junction