Case Number : Case 44 Posted By: Guest

Phillip McKee - Overseas consultations (USA) Wrote:

Although the correct diagnosis is bullous pemphigoid, with just this image, all you can do is to give a list of differential diagnoses. Immunofluoresent studies and the clinical information would be essential before you could come to a final diagnosis. The differential diagnosis includes bullous pemphigoid, mucosal pemphigoid, pemphigoid gestationis, linear IgA disease, inflammatory EBA, bullous insect bite reaction, bullous drug reaction and bullous eosinophilic cellulitis.

Submitted on 10/08/2010 21:21
________________________________________
Wayne Grayson - (Johannesburg, South Africa) Wrote:

Subepidermal vesiculobullous dermatosis, with many eosinophils. In the absence of clinical data, one would have to entertain conditions such as bullous pemphigoid, vesicular pemphigoid, pemphigoid gestationis, a drug reaction or an arthropod bite reaction in the histological differential diagnosis.

Submitted on 10/08/2010 17:28
________________________________________
Phillip McKee - Overseas consultations (USA) Wrote:

Good morning all. The infiltrate is mainly eosinophils and this is a very early lesion. Perhaps that will make the diagnosis easier. Thank you for the kind thoughts. The 4th edition will come out in November 2011. In November 2010 a new book wil come out which should appeal particularly to residents.

Submitted on 10/08/2010 15:42
________________________________________
Marcela Saeb Lima - MSL Dermatopato (Mexico City) Wrote:

Lovely pic! Good morning everyone... I complete agree with Juan Carlos, just by the histology features with those neutrophilic papillary microabscesses we could think of Dermatitis herpetiformis, however, I do also see eosinophils so this variant of herpetiform bullous pemphigoid could enter the differential diagnosis. The clinical info is necessary as so the IF.

Submitted on 10/08/2010 13:04
________________________________________
David Bell - (UK) Wrote:

Wonderful site Prof. McKee. With the sub-epidermal seperation bullous pemphigoid would be on the top of my list with pemphigus gestationis. When is your next addition of the Pathology of the Skin book coming out as the editions seem to get better and better?

Submitted on 10/08/2010 12:01
________________________________________
Miah S - (UK) Wrote:

Interesting case. Spongiosis with some eosinophils. I think we need to broaden the differentials and so I would include Grover's disease, pemphigus vulgaris and vegetans to the list.

Submitted on 10/08/2010 10:29
________________________________________
Amira Tawdy - Cairo University (Egypt) Wrote:

bullous pemphigoid Dear sir yesterday case was marvellous many thanks indeed

Submitted on 10/08/2010 08:55
________________________________________
Richard Carr - Warwick (UK) Wrote:

Subepidermal blister with eosinophils prominent (I think). Spongiosis and normal keratin layer (i.e. acute process and a nice early biopsy). DH unlikely as usually impossible to get a nice early lesion before the patient scratches it off and usually (but no always) neutrophils predominant in early lesions. In rough order of probability Bullous pemphigoid, pemphigoid gestationis and less likely bullous insect bite or bullous drug eruption

Submitted on 10/08/2010 08:47
________________________________________
Mona Abdel-Halim - Dermatology Department, Faculty of Medicine, Cairo University (Egypt) Wrote:

Ssubepidermal separation. The infiltrate is made predominantely of esinophils. Bullous pemhigoid or Herpes gestationis.

Submitted on 10/08/2010 06:23
________________________________________
Eman El-Nabarawy - Dermatology Department,Faculty of Medicine, Cairo university. (Egypt.) Wrote:

Subepidermal blister with eosinoplilic infiltrate.Bullous pemphigoid or herpes gestationis.

Submitted on 10/08/2010 05:01
________________________________________
Eduwiges Martínez Luna - Hospital General Gea González (Trainne) (Mexico City) Wrote:

bullous pemphigoid DDx, herpes gestationis, epidermolysis bullosa acquisita.

Submitted on 10/08/2010 04:06
________________________________________
Juan Carlos Garcés - Hospital Oncológico / Hospital Luis Vernaza (Guayaquil Ecuador) Wrote:

Good evening.. I am not sure if they are neutrophils o eosinophils, but it seems to be papillary abscesses of Dermatitis herpetiformis

Submitted on 10/08/2010 00:44
________________________________________