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JAMA Dermatology Clinicopathological Challenge
April 2015

Polymorphic Blistering Eruption and Stomatitis in a Patient With Non-Hodgkin Lymphoma

Author Affiliations
  • 1Baylor University Medical Center, Dallas, Texas
JAMA Dermatol. 2015;151(4):439-440. doi:10.1001/jamadermatol.2014.4361

A man in his 70s with a history of T2N2 melanoma, locally metastatic squamous cell carcinoma, and non-Hodgkin follicular lymphoma presented with weakness, a blistering erythematous eruption, and painful oral lesions of 1 month’s duration. On physical examination, the patient was in severe discomfort with limited movement owing to cutaneous pain. He was cachectic and had widespread erosions and tense and flaccid bullae with overlying crust affecting his trunk and extremities (including the palms and soles) but sparing his scalp (Figure, A). He had severe stomatitis with localized hemorrhagic lesions, shaggy erosions on the buccal and gingival mucosa, and erythematous macules on his hard and soft palates (Figure, B). Findings from laboratory tests, including a complete blood cell count and a comprehensive metabolic panel, were unremarkable except for mild anemia. Results from a computed tomographic scan of the chest and neck showed adenopathy suspicious for lymphoproliferative disorder or potentially metastatic disease. A punch biopsy for histopathologic examination (Figure, C) and direct immunofluorescence (DIF) was performed, and serum was tested for indirect immunofluorescence (IIF) on rodent epithelium (Figure, D).

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