PMC5771756_01
A, Erythroderma with widespread and confluent epidermal detachment resembles toxic epidermal necrolysis. B, Severe mucositis including erosive cheilitis with hemorrhagic crust was also present.
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fig1
A painful stomatitis and hemorrhagic erosions involving the lips were also present (Fig 1, B). After a presumptive diagnosis of TEN, the patient was admitted for in-patient management.
A, Suprabasilar acantholysis with tombstoning of the basilar keratinocytes (single arrow) and keratinocyte necrosis (double arrow) are present together. B, Vacuolar interface dermatitis (single arrow) underlies keratinocyte apoptosis. C, Overlying the intraepidermal blister, there is parakeratosis and dymaturation, with dyskeratotic cells in the stratum corneum (single arrow), indicative of chronicity. D, Weak focal cell surface (single arrow) and junctional (double arrow) reactivity. (A-C, Hematoxylin-eosin stain; original magnification: A, x100; B and C, x200.) (D, Anti-IgG direct immunofluorescence; original magnification: x100.)
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fig2
Parakeratosis and dysmaturation, indicative of chronicity, were also evident (Fig 2, A-C). Direct immunofluorescence highlighted cell surface and junctional reactivity with IgG (Fig 2, D).
PMC5771756_02