September 2021 - Case of the Month
A 24-year-old woman presented with a several year history of evolving 'lumps' especially on the central chest. The lady had mild facial acne and was otherwise well.
A 67 year old woman was referred urgently with a rash that started on her legs spreading proximally to affect the trunk and limbs. The rash was uncomfortable. A few days later the rash started to blister and the patient also developed blisters in her mouth, there was no genital involvement. There was no other relevant skin or past medical history and there were no new medications.
The rash was erythematous with annular and polycyclic lesions, most of which were flat but some of the leading edges were palpable. The blisters were tense.
What is the differential diagnosis?
The main differential was between bullous pemphigoid and liner IgA disease. The other diagnosis initially considered was erythema gyratum repens (80% of cases are associated with internal malignancy), which presents with a series of concentric, figurate bands resembling the grain of wood.
General examination, a full range of blood tests and a CXR (all performed by the GP) were normal. Bloods for skin antibodies were inconclusive. A biopsy of a lesion showed an intact epidermis with a subepidermal blister. A biopsy of the perilesional skin for direct immunofluorescence showed linear deposition of IgG along the basement membrane.
The histological features were in keeping with bullous pemphigoid, however, given the unusual presentation the histology and patient were presented at our monthly dermatology departmental meeting, where the consensus was that of bullous pemphigoid.
Please refer to the chapter on blistering disorders for more information.
Copied with kind permission of South Tees Foundation Trust
A 24-year-old woman presented with a several year history of evolving 'lumps' especially on the central chest. The lady had mild facial acne and was otherwise well.
A 52 year old man presented with a one year history of skin lesions predominantly on his hands, ears and scalp. He was also complaining of painful swollen fingers associated with morning stiffness. There was no family history of skin or joint problem...
A 72 year old man was referred with a rash, predominantly on the legs. The patient was systemically well and the lesions were only mildly symptomatic. The lesions presented as one to several at a time lasting several weeks. They had not res...
Welcome back to the new look PCDS website, and our first case. This lady was referred as a 2-week wait with a changing lesion on the right temple.
A 15 year old lady was referred for a diagnostic opinion for skin changes presenting in birth, affecting the right upper back, shoulder, antecubital fossa and dorsal wrist. The patient was asymptomatic and otherwise well.
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