case_images: PMC11835416_01
case_images: Well-defined violaceous, coalescent tense bullae filled with clear fluid over right palm (a), small, crusted papule over upper lip, small erythematous eroded lesion over left buccal mucosa, sublingual area, and small white striae over hard palate (b), dorsal aspect of distal right leg (c), and right sole (d).
case_images: cde-2025-0017-0001-543523_F01.jpg
case_images: PMC11835416_01_cde-2025-0017-0001-543523_F01.jpg
case_images: F1
case_images: On clinical examination, the following lesions were found, large well-demarcated violaceous, coalescent tense bullae filled with clear fluid over both palms (Fig. 1a), both dorsal aspect of distal leg (Fig. 1c) and sole (Fig. 1d), small crusted papule over upper lip, small erythematous eroded lesion over left buccal mucosa, sublingual area, small white striae over hard palate, amalgam teeth filling (Fig. 1b).
case_images: a Low-power view shows band-like\lichenoid inflammation at dermoepidermal junction (H/E stain, original magnification, x40). b High-power view shows basal layer squamatization and vacuolization of the basal layer with focal subepidermal cleft/blister formation.
case_images: cde-2025-0017-0001-543523_F02.jpg
case_images: PMC11835416_01_cde-2025-0017-0001-543523_F02.jpg
case_images: F2
case_images: Direct immunofluorescence studies for IgG, IgM, IgA, C3, and fibrinogen were all negative (Fig. 2a, b).
case_images: The patient demonstrated significant improvement in both cutaneous and mucosal lesions: both hands (a), both legs (b), upper lip and left buccal mucosa, sublingual area (c), right sole (d) after receiving adalimumab for a total of 10 weeks, with full remission.
case_images: cde-2025-0017-0001-543523_F03.jpg
case_images: PMC11835416_01_cde-2025-0017-0001-543523_F03.jpg
case_images: F3
case_images: After she completed 20 weeks of adalimumab administration, she showed marked improvement of both mucosal and cutaneous lesions with almost complete resolution (Fig. 3).