Case Number : Case 2090 - 11 June 2018 Posted By: Limin Yu

Subepidermal clevage with necrotic epidermis and dermal 'silence' . The only condition that comes to my mind is toxic epidermal necrolysis

Agree .TEN.

A single lesion of TEN?  Is it possible? Histologically full agree with Colleagues. 

The histologic changes are in the spectrum of EM/TEN/SJS. Clinically this lesion was more compatible with EM.

My first thought was TEN. I am glad that we are all on the same page and Dr. Yu gave us the final answer which is consistent with what we thought. But I also want to comment that these histologic features are not pathognomonic for TEN. I believe that the epidermal necrosis can happen in any old blister. Therefore cell poor BP can show similar features like those in this case, and PCT cannot be excluded.

Actually here we see rounded pink bodies in the epidermis which is typical for individual cell necrosis (rather than coagulative) which is the clue for the diagnosis.

I’d want to rule out pemphigoid and Clinical history should help. If any Clinical concern for pemphigoid, consider DIF.  I often see a rare necrotic keratinocytes in blister roof of pemphigoid and can be cell poor.  Old but interesting reference...

https://www.ncbi.nlm.nih.gov/pubmed/2409931