case_images: PMC11745287_01
case_images: (A) Diffuse erythema and desquamation at disease onset. (B) Reduction in erythema with some bullae. (C and D) Exfoliation of large areas resembling TEN.
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case_images: A 52-year-old black female patient with no comorbidities one week after using prednisone, ceftriaxone and pantoprazole for pharyngitis, had presented diffuse erythema with desquamation all over the skin (Fig. 1A). After the intravenous corticosteroid, the patient was maintained on daily oral prednisone 60 mg, when small bullae started to appear (Fig. 1B), without mucosal involvement and with mild eosinophilia. On the tenth day, epidermal detachment began to occur, resembling TEN (Fig. 1C and D), there was an increase in the eosinophilia (reaching 3,700 eosinophils/mm3.
case_images: Light Microscopy - (A) Subepidermal bulla, without epithelial necrosis. (B) Eosinophils in the dermis. (C) Eosinophils within the bulla. (Hematoxylin & eosin, x 200 and x 400).
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case_images: A bulla was then biopsied and on histopathology subepidermal cleavage, without epithelial necrosis and with significant eosinophilic infiltration in the dermis and inside the bulla were observed (Fig. 2).
case_images: Immunohistochemistry with anti-IgG antibody showing positivity on the floor and roof of the bulla (arrows).
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case_images: IgG deposition on the floor and roof of the bulla (Fig. 3). Indirect immunofluorescence showed linear positivity for IgG in the BMZ.
case_images: (A) Re-epithelialized hypochromic areas, erosions resulting from the first worsening episode and new bullae. (B) Almost complete re-epithelialization of the lesions.
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case_images: On the twentieth day, there were areas of re-epithelialization, erosions of the initial bullaes and new bullae concomitantly (Fig. 4A). The condition was controlled after four weeks of 40 mg prednisone (Fig. 4B).