PMC8407525_01
Clinical manifestation and histopathological findings of herpetiformis-type drug-induced pemphigus caused by tislelizumab before and after glucocorticoid therapy. (A-C) Clinical manifestation before glucocorticoid therapy; (D-F) clinical manifestation after glucocorticoid therapy; (G and H) histopathological findings: epidermal spongiosis, intraepidermal cleft, acantholytic cells in the bulla, edema and mixed type inflammatory infiltration containing eosinophils in the papillary dermis (H&E staining, G, x100; H, x200); (I and J) direct immunofluorescence (DIF) findings: intercellular intraepidermal C3 deposition (I) and IgG deposition (J) within the lower part of epidermis.
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On physical examination, multiple annular and herpetiform vesicles and bulla containing clear fluid with a range of 0.5-2 cm in diameter over erythematous background on the scalp, face, trunk, upper limbs, hands were observed (Figure 1A-C). Histopathological findings of a bulla revealed epidermal spongiosis, intraepidermal cleft, acantholytic cells in the bulla, edema and mixed type inflammatory infiltration containing eosinophils in the papillary dermis (Figure 1G and H). Direct immunofluorescence (DIF) assay of the perilesional skin showed intercellular intraepidermal C3 deposition and IgG deposition within the lower part of epidermis (Figure 1I and J). The blisters and erythema improved (Figure 1D-F).
The timeline of the patient's diagnosis and treatments.
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The timeline of the patient's diagnosis and treatments is presented in Figure 2.