A Young boy presents with multiple flaccid bullous lesions over trunk with some oral mucosal lesions. Most likely finding on immunofluorescence study of the biopsy specimen would be
High-Yield Explanation
Pemphigus Vulgaris Bullous pemphigoid Autoantibodies against Desmosomal proteins Hemidesmosomal proteins Age 40-60 yrs 60-75 yrs Initial site Oral mucosa Lower extremities Bullae Flaccid Tense Pruritus Mild/- Nonexistent or severe Nikolsky's sign + - Mucosal involvement +(in almost all patients) - (10-40% only) HPE Suprabasal acantholytic blisters (Tombstone appearance) Q Subepidermal blisters (eosinophil-rich dermal infiltrate) DIF IgG & C3 deposits at the intercellular substance of epidermis ("Fishnet appearance")Q IgG, C3, and IgA/IgM at BM zone. IIF Circulating IgG antibodies to the intercellular substance of epidermis. Anti-BM zone antibodies IgG Rx Steroids + immunosuppressants Dapsone Gold Steroids Immunosuppressants Dapsone Postinflammatory Hyperpigmentation + - (Ref. Harrison's 19th ed. Table 55-1)