Case Number : Case 2370 - 22 July 2019 Posted By: Dr. Hafeez Diwan

Acantholytic suprabasal disorder, with many round corps and grains, and other findings that recall Darier Disease. But some pseudo-cobblestone pattern, pemphigus vulgarisms-like, should be more in keeping with Grover's disease.

patient has renal failure and he has a supra basal acantholytic bulla. there is layer of epidermal necrosis. there are some corps and grains. there is dermal inflammation. why there is epidermal necrosis I wonder. these things I have not seen in hailey Hailey or grovers disease

if sub epidermal bulla then epidermolysis bulls acquisitor or porphyria etc would be my line of thoughts

I would like to have DIF results before concluding. 

Acantholysis with dyskeratosis. In view of older age and renal failure, I would consider Grover's disease. There have been some reports of Grover's disease associated with chronic renal failure and dialysis. DIF study needed to exclude pemphigus.

I tjink the diagnosis is between Darier disease and Grover disease. The histopathologic pictures are more consistent with Grover disease, as we can see different morphologic spectros like pemphigus-like and Darier-like epidermal alterations. The association of Grover disease with kidney disease is more present with chronic renal failure, not acute, and despite some pappers linking them both, I suspect that this could be more consistent with the usually more advanced age of this population. In contrast, Darier disease is caused by mutations in a cellular calcuim transporter and these patients can present with renal diseases strongly associated with Darier disease. Well, this doesn´t answer the question of wich disease is this. Particularly, I would call the clinician and ask for the clinical distribution of the lesions, looking for nail diseases, axilar, etc...

Grover disease.