UPMC Dermatopathology "Case of the Month" Presentations
UPP - Department of Dermatology, Dermatopathology Unit
Arthur Huen, MD, PhD, Alexandra Zhang, MD, Jill Buckthal-McCuin MD, Arash Radfar MD, PhD
FEBRUARY 2008 CASE OF THE MONTH
CLINICAL FINDINGS
38 y/o African American woman presented with history of tongue ulceration and blistering of lips and mouth that had gotten considerably worse over a period of 6 months. Because of pain from these blisters and ulcers, she has had difficulty eating and has lost 30-40 pounds unintentionally. More recently, she had begun to note genital irritation, however, did not recall any blisters in that area. She also notes having had blisters on her arms and trunk
Examination of the tongue revealed multiple erosions (Fig 1). Bilateral buccal mucosa had multiple erosions with borders of erosions creating a white reticulated pattern (Fig 2 and 3). A few hyperpigmented macules with atrophic central areas were also observed on the chest and midback. On the left medial thigh, there was a 3 cm hypertophic, raised plaque along intertriginous skin that appeared mildly edematous and macerated (Fig 4).
A punch biopsy specimen was obtained from the Left medial thigh showed an acanthotic epidermis with suprabasilar acantholysis (Fig 5 and 6). Inflammatory infiltrate in the papillary dermis was composed of lymphocytes, numerous eosinophils and some neutrophils. An eosinophilic microabscess was also observed in the epidermis. Immunofluorescence showed intercellular staining with IgG (Fig 7) and C3 in the suprabasilar epidermis.
None obtained.
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