Case Number : Case 673 - 11 Jan Posted By: Guest

Bullous dermatosis, lesion showing a subepdermal blister containig a few neutrophils, eytrocytes and lymphocytes. The dermal papillary connective tissue remiscent of dermatotis herpetiformis. The dermis contains a perivascular inflammatory cell infiltrat. Need immunfluorescence. Bullous systemic lupus erythematosus/Chronic bullous disease of childhood/EBA?

I think the real plan of cleavage is subcorneal, the papillary dermis shows edema. There is few acantholytic cells in the blister cavity together with lots of neutrophils. Also there is spongiosis and exocytosis of neutrophils and lymphocytes. Together with clinical correlation, this is bullous impetigo.

[quote name='Dr. Mona Abdel Halim' timestamp='1357913357']
I think the real plan of cleavage is subcorneal, the papillary dermis shows edema. There is few acantholytic cells in the blister cavity together with lots of neutrophils. Also there is spongiosis and exocytosis of neutrophils and lymphocytes. Together with clinical correlation, this is bullous impetigo.
[/quote] Agree

Bullous impetigo is correct and Mona's description and clinical correlation
perfect!! Nice clue to the plane of cleavage is the floating
stratum corneum sign (top right). This can also be seen in superficial pemphigus.
Bacterial cocci were present on H&E (at higher power) and confirmed on Gram
(I did not want to make it too easy). Neutrophils have very potent enzymes and
can produce acantholysis in bullous impetigo which is favoured given the clinical
information (but superficial and IgA pemphigus would be in the differential
histologically).

Regards to all and best wishes for 2013.

nice bullous impetigo. thanks