<prompt> A middle-aged woman is revealed to have subepithelial bullae with granular IgA deposits on basement membrane and she has some degree of gluten sensitivity. What is the diagnosis?Pemphigus foliaceusPemphigus vulgarisDermatitis herpetiformisBullous pemphigoid  <response>: Ans. c Dermatitis herpetiformis Ref. RobbinS pathology 8th ed., 484; Harrisons 17th ed., Table 55-1DERMATITIS HERPETIFORMIS DH is cha by intensely pruritic, papulovesicular skin lesions symmetrically distributed over extensor surfaces. All have asso gluten-sensitive enteropathy, and 90 express the HLA-B8DRw3 and HLA-DQw2 haplotypes. Biopsy of early lesional neutrophil-rich infiltrates in dermal papillae. Older lesions subepidermal bulla. Studies demonstrate granular deposits of IgA in the papillary dermis and along the epidermal BM zone. High-avidity IgA autoantibodies against epidermal transglutaminase 3. Increased incidence of thyroid abnormalities, achlorhydria, atrophic gastritis, and anti gastric parietal cell autoantibodies. Rx: The mainstay of treatment of DH is dapsone, a sulfone and Gluten free diet.InfectiousAutoimmune Associations with Lymphoma Gluten enteropathy Intestinal T-cell lymphoma Helicobacter pylori Primary gastric malt lymphoma or DLBCL Chlamydia psittaci Ocular adnexal malt lymphoma Borrelia burgdorferi Cutaneous malt lymphoma Hepatitis C virus Splenic marginal zone lymphoma Campylobacter jejuni Immunoproliferative small intestinal diseaseIPSID or heavy chain disease Sjogrens syndrome Extranodal malt lymphoma or DLBCL Hashimotos thyroiditis Extranodal malt lymphoma or DLBCL 