PMC9800862_01
Skin and oral lesions of the patient. (A-D) Widespread red papules, edematous erythema, erosions, and multiple crusts on the neck, trunk, and extremities. (E-G) Close-up view of the abdomen, back, and arm. (H) Violet plaques with white stripes on the right buccal mucosa.
fmed-09-1023458-g0001.jpg
PMC9800862_01_fmed-09-1023458-g0001.jpg
F1
Physical examination revealed widespread red papules, edematous erythema, and multiple crusts on the scalp, face, neck, trunk, and extremities (Figures 1A-G). Violet plaques with white stripes were observed on the bilateral buccal mucosa and soft palate (Figure 1H).
Histopathological and immunofluorescent findings. (A, B) Histopathology demonstrated intercellular epidermal edema, a subepidermal blister with an underlying sparse dermal perivascular infiltrate of lymphocytes and eosinophils. [H&E staining, original magnification, x 50 (A), x 200 (B)]. (C, D) Direct immunofluorescence showed linear depositions of IgG (A) and C3 (B) at the basement membrane zone. (E) Indirect immunofluorescence utilizing monkey esophagus substrate demonstrated a linear deposition of serum IgG along the basement membrane zone.
fmed-09-1023458-g0002.jpg
PMC9800862_01_fmed-09-1023458-g0002.jpg
F2
Histopathology demonstrated intercellular epidermal edema, a subepidermal blister with an underlying sparse dermal perivascular infiltrate consisting of lymphocytes and eosinophils (Figures 2A,B). IgG and complement component 3 at the BMZ (Figures 2C,D). Indirect immunofluorescence utilizing monkey esophagus substrate demonstrated serum anti-BMZ autoantibodies of IgG at 1:40 dilution (Figure 2E).
Lesions on the dorsal aspects of the hands. (A) The edematous erythema and crusts before therapy. (B) The violaceous flat-topped papules and plaques after therapy. (C) By dermatoscope, Wickham's striae were presented, a feature of lichen planus.
fmed-09-1023458-g0003.jpg
PMC9800862_01_fmed-09-1023458-g0003.jpg
F3
More interestingly, the edematous erythema and crusts on the dorsal aspects of the hands (Figure 3A) improved after therapy and left some violaceous flat-topped papules and plaques (Figure 3B). Wickham's striae were observed on those papules and plaques by dermatoscope (Figure 3C), which were the hallmark of LP.
The remaining lesions after treatment of dupilumab and systemic corticosteroids for 2 months. (A-C) Most of the red papules, edematous erythema, and erosions cleared and left pigmentation.
fmed-09-1023458-g0004.jpg
PMC9800862_01_fmed-09-1023458-g0004.jpg
F4