case_images: PMC10043161_01
case_images: CT (16 August 2021): [(A), white arrow] Right inferior abdominal wall metastases; [(B), black arrow] hepatic caudate and inferior vena cava metastases and inferior vena cava invasion. CT (13 April 2022): [(C), white arrow] Right inferior abdominal wall; [(D), black arrow] the caudate lobe of liver and inferior vena cava. CT, computed tomography.
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case_images: f1
case_images: In April 2022, he achieved partial remission (PR) after 10 cycles ( Figure 1 ).
case_images: (A) Skin lesions before steroids. (B) Skin lesions after 10 months of steroids. (C) Subepidermal blister (hematoxylin and eosin staining, 40x). (D) Eosinophils existed in the blister (hematoxylin and eosin staining, 100x). DIF studies showed linear deposition of C3 [(E), white arrow] and IgG [(F), red arrow] along the basement membrane zone.
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case_images: f2
case_images: The lesions subsequently aggravated, forming strained blisters filled with serous fluid ( Figure 2A ) in February 2022. Hematoxylin and eosin (HE) staining showed subepidermal blisters, necrosis of the upper epidermal wall, and serous exudation ( Figure 2C ). A large number of eosinophils were present in the blister, while lymphocytes, monocytes, and eosinophils were infiltrated around the vessels in the lower dermal vasodilation ( Figure 2D ). IgG ( Figure 2F ) along the basement membrane zone. IgG antibodies were positive for Methylprednisolone was tapered to 4 mg orally twice daily without lesion recurrence ( Figure 2B ).
case_images: Timeline of the treatment processes. XELOX, oxaliplatin + capecitabine. PD, progressive disease, PR, partial response.
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case_images: f3
case_images: At the time of writing this report, the patient's rectal cancer reached partial response ( Figure 3 ) with a progression-free survival (PFS) of 8 months (we expected a longer PFS).