PMC9580082_01
Case 1 - Erosions and tense non-hemorrhagic vesicles and bullae on the left thigh (a). Incisional biopsy for routine haematoxylin and eosin staining (100x magnification) with epidermal spongiosis, subepidermal clefting, and increased dermal eosinophils (b). Direct immunofluorescence studies (200x magnification) from perilesional skin demonstrate IgG (c) and C3 (d) deposition along the dermal-epidermal junction with increased intensity of C3 deposition.
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Physical examination revealed pink plaques with both non-hemorrhagic and hemorrhagic bullae scattered on the extremities, neck, chin, and torso (Figure 1(a)). Pathology revealed spongiosis of the epidermis with perivascular lymphoeosinophilic infiltrate in the superficial dermis (Figure 1(b)). DIF showed a linear deposition of IgG and C3 along the dermal-epidermal junction (Figure 1(c)-(d)).
PMC9580082_02
Case 2 - Erosions and hemorrhagic and non-hemorrhagic bullae on the right dorsal forearm (a). Incisional biopsy for routine haematoxylin and eosin staining (100x magnification) with subepidermal separation, papillary dermal festooning, and brisk dermal lymphoeosinophilic inflammation (b). Direct immunofluorescence studies (200x magnification) from perilesional skin demonstrate IgG (c) and C3 (d) deposition along the dermal junction with preferential staining of the roof of the epidermal split.
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On physical exam, non-hemorrhagic and hemorrhagic bullae were observed on the right forearm (Figure 2(a)) with smaller vesicles noted on his calves. Incisional biopsies were completed for routine histopathology and DIF (Figure 2(b)-(d)).