case_images: PMC10932511_01
case_images: Widespread ill-defined ovoid erythematous patches and plaques symmetrically distributed over the trunk and extremities with a few flaccid bullae (single black arrow) that were easily de-roofed (double black arrow). A zoomed picture of the lower buttock area showing an atypical target lesion with central dusky area (single white arrow) surrounded by erythematous, edematous skin (double white arrow).
case_images: jchim-14-01-066f1.jpg
case_images: PMC10932511_01_jchim-14-01-066f1.jpg
case_images: f1-jchim-14-01-066
case_images: Skin exam (Fig. 1) notable for ill-defined ovoid erythematous patches and plaques symmetrically distributed over the trunk and extremities involving 47% of skin using Wallace rule of 9s with sparing of the face, lip, and palms.
case_images: There is a minimal lymphohistiocytic inflammatory dermal infiltrate (single arrow) in the papillary dermis which appears to be primarily perivascular. Rare eosinophils are seen. Scattered dyskeratotic cells (double arrow) and acantholysis are present within the blister roof.
case_images: jchim-14-01-066f2.jpg
case_images: PMC10932511_01_jchim-14-01-066f2.jpg
case_images: f2-jchim-14-01-066
case_images: Histopathology (Fig. 2) revealed "Severe interface vacuolar dermatitis with numerous necrotic keratinocytes, focal full-thickness necrosis of epidermis and basket weave orthokeratosis" while direct immunofluorescence on Fig. 3 showed "abundant cytoid bodies and focal areas of granular