PMC9538274_01
(A) Polycyclic erythematous plaques with central clearing were noticed on the left arm. (B) Yellow tense fluid-filled bullae were present on a background of annular and polycyclic erythematous plaques on the left thigh.
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There were grouped tense fluid-filled bullae on his upper thighs on an erythematous base (Figure 1).
(A) Lesional skin specimen with H&E stain revealed broad subepidermal blister with a superficial perivascular infiltrate (x4). (B) Numerous eosinophils are seen within the blister cavity (x20). (C) Both eosinophils and neutrophils are seen lining the dermal-epidermal junction and within dermal papillae (x40).
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At the periphery of the blister, both neutrophils and eosinophils were seen within dermal papillae and lining the dermal-epidermal junction (Figure 2).
(A) Direct Immunofluorescence of clinically perilesional skin revealed a strong linear deposition of IgA (x40) and (B) weaker IgM co-reactivity along the dermal-epidermal junction (x40).
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IgA and IgM along the basement membrane zone (Figure 3) with no immunoreactivity for C3 or IgG. IIF was positive for IgA basement membrane zone antibody.