PMC10265503_01
Clinical manifestations of this patient. The clinical features on the back (A, D), posterior side of both lower limbs (B, E) and right thigh (C, F) at Day 0 and Day30 are shown.
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Physical examination revealed numerous papules and nodules present on the trunk and extremities along with many hemorrhagic crusted erosions and hyperpigmented macules ( Figures 1A-C ). After one-month follow-up, new skin lesions ceased to form, re-epithelialization was observed in most erosions, and pruritus improved significantly ( Figures 1D-F ).
Results of histopathological and direct immunofluorescence. (A) Histopathological features of biopsy from lesioned skin on the back (HE staining, original magnification, x100). (B-D) Direct immunofluorescence (DIF) for IgA (B), IgG (C) and C3 (D).
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Mixed inflammatory cells infiltrated around small vessels in the dermis ( Figure 2A ).
Immunoblotting analysis of normal epidermal extracts. Lane 1, bullous pemphigoid (BP) control serum, which is positive for autoantibodies against BP180 and 120kDa-BP180. Lane 2 and 3, patient serum, which is positive for IgG (lane 2) autoantibodies against 97kDa-BP180, and IgA (lane 3) autoantibodies against both 120kDa-BP180 and 97kDa-BP180.
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BMZ. Indirect immunofluorescence on human salt-split skin was negative. Immunoblotting (IB) using epidermal extracts showed IgA antibodies reacted with 97-kDa and 120-kDa of BP180 and that IgG antibodies reacted with 97-kDa of BP180, while showed no antibodies against 290-kDa type VII collagen and laminin-gamma1 in the extracts of dermis ( Figure 3 ). BP180 NC16a domain, BP230, and laminin 332 were negative by enzyme-linked immunosorbent assay (ELISA).