Case Number : Case 701 - 21 Feb Posted By: Guest

Subepidermal bullous disorder with neutrophils, nuclear dust and few eosinophils with evidence of vasculitis. DD includes Linear IGA disease, DH, Epidermolysis bullosa acquisita, bullous LE, Drugs and Scabies. IF is essential.

Subepidermal bullous disorder with neutrophils, nuclear dust and few eosinophils with evidence of vasculitis. DD includes Linear IGA disease, DH, Epidermolysis bullosa acquisita, bullous LE, Drugs and Scabies. IF and clinical histroy are essential.

Subepidermal vesiculobullous disorderd with microabscesses and a suggestion of karyorrhexis. No vasculitis.
DD: Dermatitis herpetiformis, Linear IgA disease. Needs immunofluorescence and clinicopathological correlation.

[b]Sorry I meant with NO evidence of vascilitis and changed it in the second comment but has not been changed.[/b]

Subepidermal bullous disorder with neutrophils and few eosinophils. DD includes Linear IgA bullous dermatosis, DH, Epidermolysis bullosa acquisita, bullous LE. Presence of dust (?fibrin deposition) may favor bullous LE!!

Agree....

Subepidermal blister with neutrophils, eosinophils and nuclear dust.
I don’t think it is bullous pemphigoid because there’s no eosinophils predominance and epidermic roof is not flattened. Moreover, age is not typical.
Neither do I think it is dermatitis herpetiformis. Site of the lesions is not typical. Itching is not a complaint. There are no neutrophilic aggregates within papillary dermal tips.
Inflammatory cells are more than few to construe a diagnosis of epidermolysis bullosa acquisita. Sites of trauma are spared.
Lesions of bullous lupus erythematosus favor sun-exposed areas. There are no mucin deposits.
Linear IgA bullous dermatosis is my preferred hypothesis.
Anyway, all those hypothesis cannot be definitely ruled out and direct immunofluorescence is critical to achieve the correct diagnosis.

DIF for IgA pemphigus (IEN variant). Papillary neutrophilic microabscess has been well documented in this entity.

I agree with Dr. Rocha's opinion of L[color=#1C2837][font=arial, verdana, tahoma, sans-serif][size=4]inear IgA bullous dermatos[/size][/font][/color][color=#1C2837][font=arial, verdana, tahoma, sans-serif][size=4]is for this subepidermal bullous dermatosis (at least [/size][/font][/color][size=4]while the DIF is pending), with[/size][size=4] the clinical history implying a unilateral pseudo-herpetiform distribution. [/size][size=4]History of inflammatory bowel disease or recent drug/Abx exposure may be additional useful clinical associations.
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Linear IgA bullous dermatosis. Immunofluorescence showed linear IgA.