PMC6861207_01
Timeline of the patient's diagnoses and treatments (in red information related to pemphigus vulgaris, in green information related to kaposi's sarcoma and in yellow information related to the lung adenocarcinoma).
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F1
Figure 1 shows a timeline of the patient's diagnoses and treatments.
Pemphigus vulgaris lesions on the left forearm of a patient with lung adenocarcinoma treated with nivolumab showing multiple erosions and hemorrhagic crusts. Fresh blisters are not present anymore (A). Skin condition of the patient 4 weeks later under therapy with prednisolone 20 mg daily and methotrexate 10 mg weekly as well as topical therapy (B). Detailed image of lesional epidermis, dermo-epidermal junction (DEJ) and dermis in histology (200 x) showing a suprabasal acantholysis as well as perivascular infiltrates of lymphocytes, histiocytes, eosinophilic, and neutrophilic granulocytes in the upper dermis. The upper part of the epidermis is focally missing due to the intralesional punch biopsy (C). Perilesional direct immunofluorescence microscopy with FITC-labeled anti-human-IgG-antibodies (250 x) showing intercellular deposition of IgG in the epidermis (D). Ex vivo confocal laser scanning microscopy of perilesional biopsy specimen with IgG-antibodies (E-H) showing histomorphological details as well as specific intercellular binding of the IgG-antibodies mainly in the lower half of the epithelium in different imaging modes: Reflectance mode (E), overlay of reflectance and fluorescence mode (F), digital staining mode (G), and fluorescence mode (H).
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F2
Furthermore, Figure 2A shows multiple erosions and hemorrhagic crusts of the patient's PV lesions on his left forearm on admission day.