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September 20, 2010

Generalized Annular Bullous Eruption—Quiz Case

Author Affiliations


Arch Dermatol. 2011;147(1):109-114. doi:10.1001/archdermatol.2010.404-a

A 55-year-old man presented with the new onset of pruritic, burning blisters that had progressed over the previous week. The eruption had first appeared on his back and then on his chest, arms, legs, neck, and face. His pertinent medical history was negative for psoriasis. His medications included atorvastatin and metoprolol, with no recent use of nonsteroidal anti-inflammatory drugs (NSAIDs) or antibiotics. He denied fever, arthralgias, myalgias, or any other symptoms.

Physical examination revealed numerous tense annular bullae and large polycyclic urticarial plaques in a generalized distribution (Figure 1). There was palmoplantar involvement but no intraoral or ocular lesions. The patient's estimated body surface area involvement was 50%. Two punch biopsy specimens were obtained: one from affected skin for hematoxylin-eosin staining, the other from perilesional skin for direct immunofluorescence (IF) microscopy (Figure 2 and Figure 3). An immunoblot study of a serum sample demonstrated IgG antibodies against a 200-kDa protein extracted from the dermis.