PMC5437434_01
Clinical appearance before and after therapy. Ventral trunk (a), dorsal trunk (b), face(c), and hypertrophic verrucous vegetative plaques on the armpit (d).
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F1
BMI of 13.01. Blisters, erosions, and hemorrhagic crusts with hypertrophic verrucous vegetative plaques were found on the armpits, trunk, extremities, and in the perianal region (Fig. 1).
a Histopathological results of the vegetating lesions on the extremities revealed a suprabasal cleft with scattered acantholytic cells and hyperkeratosis. The subepithelial layer was filled with lymphocytes (hematoxylin and eosin. x100). b Direct immunofluorescence staining (DIF) showed deposits of immunoglobulin G (green color) in the epidermal intracellular spaces, which is characteristic of pemphigus (DIF. x400).
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F2
The subepithelial layer was filled with lymphocytes (Fig. 2a). Direct immunofluorescence (DIF) staining showed deposits of immunoglobulin G on the surface of the keratinocytes (Fig. 2b), which supported the diagnosis of pemphigus vegetans.