Light microscopic examination of the skin biopsy specimen from the blister revealed a suprabasal cleft within the epidermis. There was focal acantholysis, and basal keratinocytes exhibiting the appearance of a row of tombstones were attached to the dermis. The dermis contained an infiltrate composed of lymphocytes, neutrophils, and scattered eosinophils. A second skin biopsy specimen was obtained from perilesional skin for direct immunofluorescence studies, which revealed intercellular deposition of IgG throughout the epidermis. Because of these pathologic findings and the supporting clinical history, the patient was diagnosed as having pemphigus vulgaris. Prednisone therapy (60 mg/d in divided doses) was initiated. Because of the difficulties in controlling the disease with oral steroids alone, azathioprine was added to the patient's regimen. Treatment with prednisone and azathioprine, each administered at a dosage of 50 mg twice a day, controlled the eruption.
Mucosal Erosions and Bullae in a Child. Arch Dermatol. 2000;136(5):665-670. doi: