PMC9375974_01
(A) Scattered erythema on trunk and extremities with thick-walled blisters on the erythema. (B) Edema and erythema is seen on the face and neck with blisters at the edge of the erythema, resembling a wreath. (C) Scattered erythema, scabs, scars, and hyperpigmentation seen on trunk and extremities.
CCID-15-1611-g0001.jpg
PMC9375974_01_CCID-15-1611-g0001.jpg
f0001
Physical examination showed large areas of scattered generalized erythema with overlying blisters that resembled a wreath; scattered erosions and crusts were observed on the torso and limbs (Figures 1A and B) and erosions were seen on the oral mucosa. The erythema and blisters subsided, and the patient was discharged from the hospital (Figure 1C) after 4 weeks of treatment.
(A) A subepidermal blister with red blood cells in the blister and focal neutrophilic exudation (Hematoxylin-Eosin x40). (B) Direct immunofluorescence showing basement membrane with linear deposition of C3. (C) Direct immunofluorescence showing basement membrane with linear deposition of IgG.
CCID-15-1611-g0002.jpg
PMC9375974_01_CCID-15-1611-g0002.jpg
f0002
Histopathology showed the presence of subepidermal blisters (Figure 2A) and direct immunofluorescence showed linear deposition of immunoglobulin G (IgG) and complement 3 (C3) on the basement membrane (Figure 2B and C); the BP180 level was 146.93U/mL and BP230 antibodies were not detected (enzyme linked immunosorbent assay was performed at the Guangzhou Golden Mile Medical Laboratory Center).