RT Book, Section
A1 Miedema, Jayson R.
A1 Sayed, Christopher J.
A1 Zedek, Daniel C.
A2 Reisner, Howard M.
SR Print(0)
ID 1173789616
T1 Pathology of the Skin
T2 Pathology: A Modern Case Study, 2e
YR 2020
FD 2020
PB McGraw-Hill Education
PP New York, NY
SN REISNERPATHOL
LK accessmedicine.mhmedical.com/content.aspx?aid=1173789616
RD 2024/04/20
AB A  77-year-old  woman  presents  to  a  local  emergency  room  after  developing  numerous  blisters  over  her  trunk  and  extremities.  She  reports  that  she  recently  developed  an  intensely  pruritic  (itchy)  red  rash,  and  the  next  morning  she  was  alarmed  when  she  woke  and  noticed  large,  painful  blisters  erupting  within  the  rash.  Examination  shows  numerous  tense  bullae  with  erythematous,  indurated  borders  over  the  trunk  and  extremities.  A  dermatologist  is  called  for  consultation  and  performs  a  punch  biopsy  from  the  edge  of  one  of  the  large  blisters.  Clinical  image  and  results  of  hematoxylin  and  eosin  staining  are  shown  in  Figure  21-1.Microscopic  examination  is  most  notable  for  a  split  at  the  dermoepidermal  junction.  While  this  finding  can  be  seen  in  other  blistering  disorders,  it  is  perhaps  most  characteristic  of  bullous  pemphigoid.  Bullous  pemphigoid  is  an  autoimmune  blistering  disorder  caused  by  formation  of  pathogenic  antibodies  to  a  component  of  hemidesmosomes,  most  importantly  bullous  pemphigoid  antigen  2,  which  is  necessary  for  binding  of  the  superficial  component  of  the  skin,  the  epidermis,  to  the  deeper  component,  the  dermis.  An  accompanying  inflammatory  infiltrate  with  prominent  eosinophils  is  also  highly  indicative  of  bullous  pemphigoid.  As  discussed  in  the  cases  later,  further  diagnostic  studies  using  immunofluorescence  can  often  help  to  confirm  the  diagnosis.