case_images: PMC9800862_01
case_images: Skin and oral lesions of the patient. (A-D) Widespread red papules, edematous erythema, erosions, and multiple crusts on the neck, trunk, and extremities. (E-G) Close-up view of the abdomen, back, and arm. (H) Violet plaques with white stripes on the right buccal mucosa.
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case_images: PMC9800862_01_fmed-09-1023458-g0001.jpg
case_images: F1
case_images: Physical examination revealed widespread red papules, edematous erythema, and multiple crusts on the scalp, face, neck, trunk, and extremities (Figures 1A-G). Violet plaques with white stripes were observed on the bilateral buccal mucosa and soft palate (Figure 1H).
case_images: Histopathological and immunofluorescent findings. (A, B) Histopathology demonstrated intercellular epidermal edema, a subepidermal blister with an underlying sparse dermal perivascular infiltrate of lymphocytes and eosinophils. [H&E staining, original magnification, x 50 (A), x 200 (B)]. (C, D) Direct immunofluorescence showed linear depositions of IgG (A) and C3 (B) at the basement membrane zone. (E) Indirect immunofluorescence utilizing monkey esophagus substrate demonstrated a linear deposition of serum IgG along the basement membrane zone.
case_images: fmed-09-1023458-g0002.jpg
case_images: PMC9800862_01_fmed-09-1023458-g0002.jpg
case_images: F2
case_images: Histopathology demonstrated intercellular epidermal edema, a subepidermal blister with an underlying sparse dermal perivascular infiltrate consisting of lymphocytes and eosinophils (Figures 2A,B). IgG and complement component 3 at the BMZ (Figures 2C,D). Indirect immunofluorescence utilizing monkey esophagus substrate demonstrated serum anti-BMZ autoantibodies of IgG at 1:40 dilution (Figure 2E).
case_images: Lesions on the dorsal aspects of the hands. (A) The edematous erythema and crusts before therapy. (B) The violaceous flat-topped papules and plaques after therapy. (C) By dermatoscope, Wickham's striae were presented, a feature of lichen planus.
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case_images: PMC9800862_01_fmed-09-1023458-g0003.jpg
case_images: F3
case_images: More interestingly, the edematous erythema and crusts on the dorsal aspects of the hands (Figure 3A) improved after therapy and left some violaceous flat-topped papules and plaques (Figure 3B). Wickham's striae were observed on those papules and plaques by dermatoscope (Figure 3C), which were the hallmark of LP.
case_images: The remaining lesions after treatment of dupilumab and systemic corticosteroids for 2 months. (A-C) Most of the red papules, edematous erythema, and erosions cleared and left pigmentation.
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case_images: PMC9800862_01_fmed-09-1023458-g0004.jpg
case_images: F4