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The biopsy specimen showed a subepidermal bulla with a dense dermal infiltrate of mononuclear cells. Giemsa and Leder stains confirmed the presence of mast cells. The results of direct immunofluorescence were negative for IgA, IgM, and IgG.
A serum tryptase level was 13.3 ng/mL (reference range, 1.9-13.5 ng/mL). A complete blood cell count, serum IgE levels, electrolyte levels, liver function test results, and 24-hour urinary histamine levels were within normal limits. The patient was treated with oral diphenhydramine hydrochloride (Benadryl), topical emollients, and petrolatum-impregnated dressings for the erosions. His parents were given an adrenaline kit/epinephrine pen and a list of potential mast cell degranulators to avoid. One week later, there were no new bullae and the erosions were mostly healed.
Acute Generalized Bullous Eruption in a 2-Year-Old Boy—Diagnosis. Arch Dermatol. 2008;144(5):673–678. doi:10.1001/archderm.144.5.673-h
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