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June 2013

Hemorrhagic and Serous-Filled Vesicles and Bullae—Quiz Case

Author Affiliations
 

SECTION EDITOR: MARY S. STONE, MD; ASSISTANT SECTION EDITORS: SOON BAHRAMI, MD; CARRIE ANN R. CUSACK, MD; MOLLY A. HINSHAW, MD; ARNI K. KRISTJANSSON, MD; LORI D. PROK, MD

JAMA Dermatol. 2013;149(6):751-756. doi:10.1001/jamadermatol.2013.3314b

A 42-year-old man presented postictal after an alcohol withdrawal seizure. During the seizure he experienced a right humeral fracture. Skin examination (Figure 1) revealed ecchymosis with hemorrhagic and serous-filled vesicles and bullae, ranging in size from 0.3 to 3.0 cm. Lesions were located on the right shoulder and arm, overlying the fracture. There was no personal or family history of immunobullous disorders. Two biopsy speci-mens were taken, 1 for routine hematoxylin-eosin staining (Figure 2 and Figure 3) and the other for direct immunofluorescence.

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