A 5-year-old boy presented to the hospital with a 1-week history of multiple nonpruritic blisters. The blisters had started in his groin and genitalia and spread to his trunk and limbs. There had been no response to treatment with oral acyclovir and floxacillin, which had been prescribed by his primary care physician. There was no history of an upper respiratory tract infection, viral prodrome, drug ingestion, or vaccination prior to the onset of the blistering. The patient was otherwise healthy, and there was no family history of cutaneous disease. On clinical examination, there were numerous tense, large, hemorrhagic bullae, predominantly in the groin and genitalia (Figure 1) but with some involvement of the trunk and limbs. The results of all laboratory studies were within the normal range. A skin biopsy specimen was obtained (Figure 2), and a perilesional skin specimen was sent for direct immunofluorescence (Figure 3).
Lear JT, Smith AG. Multiple Blisters in a Young Boy. Arch Dermatol. 1998;134(5):625-630. doi: