PMC4737813_01
Clinical and histopathologic findings. Clinical features. Annular erythematous plaques with grouped peripheral tense vesicobullae on the (A) trunk and (B) legs. (C) Histopathological features. Intraepidermal blister with infiltrates of neutrophils, eosinophils and lymphocytes (H&E, x200).
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F1
Physical examination revealed annular erythematous plaques with grouped peripheral vesicobullae with intensive itch on the trunk and legs (Fig. 1A, B). A skin biopsy specimen revealed intraepidermal blister containing neutrophils, eosinophils and lymphocytes (Fig. 1C).
Immunologcal findings. DIF shows (A) immunoglobulin G (IgG) and (B) complement 3 (C3) deposition along the cell surface of keratinocytes. (C) Results of immunoblotting of normal human epidermal extracts. Pemphigus vulgaris (PV) control serum reacted with the 160-kDa desmoglein (Dsg) 1 and the 130-kDa Dsg3 (lane 1), paraneoplastic pemphigus (PNP) control serum reacted with the 210-kDa envoplakin and the 190-kDa periplakin (lane 2), bullous pemphigoid (BP) control serum reacted with the 230-kDa BP230 and the 180-kDa BP180 (lane 3), anti-desmocollin (Dsc) monoclonal antibody (mAb) (lane 4) and the patient serum (lane 5) reacted strongly with the 110-kDa a-form and the 100-kDa b-form Dsc3. DIF: direct immunofluorescence.
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F2
IgG and complement 3 (C3) depositions on keratinocyte cell surfaces (Fig. 2A, B). Indirect IF of normal human skin also revealed IgG anti-keratinocyte cell surface antibodies. Immunoblotting with normal human epidermal extracts revealed a doublet of a-form (110-kDa) and b-form (100-kDa) Dscs (Fig. 2C).