case_images: PMC10838141_01
case_images: Clinical presentation.. A and B: Multiple intact and eroded vesicles overlying erythematous plaques, and wheels with a peau d'orange appearance involving the abdomen and the neck/scalp area. C: Diffuse erythema and thickening of the skin on the back with a few erosions on the upper back; positive dermographism can be seen (arrow).
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case_images: PMC10838141_01_cureus-0016-00000051660-i01.jpg
case_images: FIG1
case_images: The underlying skin was diffusely thickened and erythematous, having an orange peel (peau d'orange) appearance (Figures 1A, 1B). Darier sign was not demonstrated; however, dermographism was demonstrated on the back and appeared positive (Figure 1C).
case_images: Hematoxylin and eosin stain.. A: The epidermis shows a subepidermal blister. Within the dermis, there is a diffuse infiltrate composed of monotonous cells. The cells do not infiltrate the epidermis. Scattered eosinophils are noted. B: Diffuse infiltrate within the dermis composed of monotonous cells with round nuclei and granular cytoplasm, and scattered eosinophils are noted.
case_images: cureus-0016-00000051660-i02.jpg
case_images: PMC10838141_01_cureus-0016-00000051660-i02.jpg
case_images: FIG2
case_images: Histological examination of the skin showed a subepidermal blister and a generalized infiltration of monomorphic granular cells concentrating within the papillary dermis with a few eosinophils (Figure 2).
case_images: Giemsa stain.. A and B: Giemsa stain confirms the increased mast cells.
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case_images: PMC10838141_01_cureus-0016-00000051660-i03.jpg
case_images: FIG3
case_images: Giemsa stain was taken up by almost all infiltrating cells which confirmed the increased mast cells (Figure 3).
case_images: Immunofluorescence.. Negative direct immunofluorescence for IgG, IgA, and C3.
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case_images: PMC10838141_01_cureus-0016-00000051660-i04.jpg
case_images: FIG4
case_images: Direct immunofluorescence was negative for IgG, IgA, and C3 which ruled out other immunobullous diseases and confirmed the diagnosis of bullous mastocytosis (Figure 4).
case_images: Follow-up. . A and B: No new vesicles or bullae, erosions are healing, and minimal post-inflammatory hypopigmentation.
case_images: cureus-0016-00000051660-i05.jpg
case_images: PMC10838141_01_cureus-0016-00000051660-i05.jpg
case_images: FIG5
case_images: The skin started to heal, the erythema reduced markedly, and no new vesicles developed (Figure 5).