case_images: PMC11748440_01
case_images: The initial presentation upon admission revealed extensive edematous urticaria-like plaques, accompanied by desquamation, erosion, excoriation, and crusting, along with a ruptured hemorrhagic bulla located on the anterior body and left leg.
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case_images: PMC11748440_01_omae173f1.jpg
case_images: f1
case_images: Dermatologic examination revealed oedematous urticaria-like plaques, scaling, erosions, excoriations, and crusts all over the body, as well as a ruptured hemorrhagic bulla on the anterior body and left leg (Fig. 1).
case_images: Bone marrow aspiration at diagnosis (A-D). (A) 100x magnification. (B) and (C) 1000x magnification with emersion oil.
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case_images: PMC11748440_01_omae173f2.jpg
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case_images: Blood Cell Count (WBC) was 23 x 109/l, the Absolute Neutrophil Count (ANC) was 644 cells/mul, the Hemoglobin (Hb) was 99 g/, and the Platelet Count (Plt) was 28 x 109/l. Bone marrow aspiration consistent with acute lymphoblastic leukemia-L1, led to the diagnosis of acute lymphoblastic leukemia in the patient (Fig. 2).
case_images: Histopathological analysis of the ruptured hemorrhagic bulla on the anterior trunk on the eighth day of treatment, using hematoxylin and eosin stain, yielded the following observations (A-D). (A) Visualized at 4x magnification. (B) Enlarged to 10x, highlighting perivascular lymphocytes indicated by a yellow arrow. (C) Enhanced to 40x, with perivascular lymphocytes marked by a white arrow. (D) Presented at 4x magnification, focusing on a non-optimal area due to the absence of the epidermis and bulla base impression, as indicated by a yellow arrow.
case_images: omae173f3.jpg
case_images: PMC11748440_01_omae173f3.jpg
case_images: f3
case_images: On the eighth day of treatment, a histopathological exam showed that the patient had bullous pemphigoid because there was necrotic epithelium and chronic inflammatory cells (Fig. 3).