Vesiculobullous eruptions


CASE #1

A 61-year-old Caucasian woman presented with a several-month history of painful erosions on her trunk and extremities. “Cold sores,” which had appeared in her mouth before the lesions on her skin, were taking longer to heal than usual. The patient had a few intact, flaccid bullae with larger areas of erosion and crusting. Gentle lateral pressure of the skin caused new blister formation. The patient also had erosions along her buccal mucosa. A biopsy specimen revealed suprabasal acantholysis with some eosinophils throughout the upper dermis. Direct immuno­fluorescence (DIF) showed immunoglobulin (Ig) G deposition around keratinocytes.

CASE #2

The patient, a 70-year-old Caucasian man with a history of hepatitis C, presented with a two-month history of mildly pruritic blisters predominantly on his lower legs. The man reported no oral involvement. Physical examination of the patient revealed tense bullae with erythematous bases on his bilateral lower extremities. He also had crusted erosions on his legs, scalp, and forearms. A punch biopsy showed a subepidermal split containing predominantly eosinophils. DIF demonstrated linear deposits of complement C3 and IgG along the basement membrane. Urinary porphyrins were also negative.

What is the diagnosis?

For CASE #1, click "NEXT." For CASE #2, click "3."

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