The American Society of Dermatopathology

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Interactive Case Study - March 2021

‎55-year-old woman with rash ‎

Olabisi Afolayan-Oloye, MD; John Pui, MD

Question 1:

A 55-year-old woman presents with rash involving the bilateral buttocks, arms, legs and lower abdomen of two days duration. The rash was initially painful and is now pruritic. The patient has a four-year history of acquired short bowel syndrome requiring total parenteral nutrition. Physical examination shows diffuse erythematous plaques with bullae that are slightly raised and tender involving bilateral upper and lower extremities, abdomen and trunk. A 5 mm punch biopsy of involved lateral lower abdomen was obtained and revealed the following histopathology (Figures 1-4).

Click the photo below to see the virtual slide.

Figure 1.

Figure 2.

Figure 3.

Figure 4.

What is the best diagnosis?