Case Number : Case 4159 - 29 December 2022 Posted By: Saleem Taibjee

Eosinophilic spongiosis in an elderly patient with history of pruritus and blisters  are the pointers towards bullous pemphigoid.

On 09/01/2023 at 14:44, Anil Patki said:

Eosinophilic spongiosis in an elderly patient with history of pruritus and blisters  are the pointers towards bullous pemphigoid.

Agree. And mostly eosinophils at the epidermal/dermal junction. 

Likely early BP given this age group. However the location and the neutrophilic microabscesses at the tips of the dermal papillae could raise the possibility of dermatitis herpetiformis.

Yes, this is bullous pemphigoid 'pre-bullous', subsequently confirmed on immunofluoresence.

I wanted to particularly draw attention to a useful histological clue which I have noticed which I call 'mini-blisters'. These are tiny foci of subepidermal clefting which are apparent histologically but not clinically. This is different to basal vacuolar degeneration, because the keratinocytes themselves are intact. These are nicely seen in the 5th image above, but also annotated below.

BW
Saleem

Nice case of Pre-BP