The American Society of Dermatopathology

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Interactive Case Study - October 2018

44-year-old with diffuse outbreak of blistering rash

Yang Li; Ilana Rosman, MD; Douglas Laurain, MD

Question 1:

A 44-year-old African American female presented to the office with approximately 2 months of multiple blisters, involving her abdomen, left ventral wrist, upper thighs and dorsal hands. The blisters were occasionally pruritic and had erupted within a few days of each other. Two punch biopsies of lesions on the right upper thigh were performed. Histopathology of lesional skin (Figures 1-3), and perilesional skin for DIF (Figure 4) reveal:

Click this image to view the virtual slide

Figure 1. 50x

Figure 2. 200x

Figure 3. 200x

Figure 4. DIF of IgA, 100x

Which of the following is the best diagnosis?