<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 64-year-old man presents to his primary care provider after noticing the development of a blistering rash. The patient states that his symptoms began 1 week ago after he noticed a blister develop on the inside of his mouth that eventually ruptured. Over the past several days, he has noticed several more blisters on his torso. The patient denies a fever or any other symptoms. He has a history of high blood pressure, for which he takes hydrochlorothiazide. He is otherwise healthy and denies any recent changes to his medication. Today, the patients temperature is 99.0F 37.2C, blood pressure is 12484 mmHg, pulse is 66min, and respirations are 12min. On exam, the patients mouth is notable for a previously ruptured blister on his left buccal mucosa. On his left flank and anterior abdomen are scattered 10-15-cm bullae that appear flaccid and filled with serous fluid. The lesions are erythematous but there is no surrounding erythema. On manual rubbing of the skin near the lesions, new blisters form within minutes. Which of the following is involved in the pathogenesis of this disease?? A: Autoantibodies against hemidesmosomes, B: Exotoxin destroying keratinocyte attachments, C: IgA antibodies depositing in the dermal papillae, D: IgG against transmembrane proteins between cells, E: Viral infection of skin,  <response>: This is a clinical vignette describing a patient with a blistering rash that began in the mouth and spread to the torso. The blisters are painless, filled with fluid, and new blisters form with friction, which are characteristic of pemphigus vulgaris. Pemphigus vulgaris is an autoimmune blistering disease caused by autoantibodies against desmoglein-3 and desmoglein-1, which are transmembrane proteins that mediate attachment between keratinocytes. The autoantibodies cause a loss of cell adhesion and blister formation. Therefore, the pathogenesis involves autoantibodies against transmembrane proteins between keratinocytes, which is choice D.Choices A, B, and E describe other blistering diseases but not pemphigus vulgaris. Choice C describes linear IgA bullous dermatosis.D: IgG against transmembrane proteins between cells 