Bullous Pemphigoid. Presented by Lyon Rowe, MD.
A 67-year-old man has had an eruption of his scalp, face, and shoulders for the past year. On one occasion, when he was receiving penicillin, tetracycline, and sulfapyridine for an infection of his neck, his lesion cleared completely. Dermatological examination showed vesicles and crusted lesions on the scalp and face. There was no scarring. Results of a previous biopsy were said to be consistent with dermatitis herpetiformis. The bullous lesion binds antihuman IgA and IgG and β1C complement (1A) at the dermal-epidermal junction. The patient's serum showed antinuclear antibody (IgA) when tested on sections of monkey's esophagus.
Discussion
Dr. Harold J. Allen: We have seen two patients in the past six months with generalized bullous eruptions, both showing the classic histopathologic findings of dermatitis herpetiformis, including papillary eosinophilic abscesses. Both exhibited high titers of circulating antibasement membrane antibodies. Thus, this patient represents yet