Lupus erythematosus-specific bullous lesions.

Lupus erythematosus (LE)-specific bullous lesions are often difficult to distinguish from other bullous diseases presenting in patients with systemic lupus erythematosus. Herein, we describe a 49-year-old woman with systemic lupus erythematosus with recurrent tense bullae on the forearms. Clinical, histopathologic, and serologic findings led to the diagnosis of LE-specific bullous lesions. We also summarize the diagnostic clues for distinguishing LE-specific bullous lesions, bullous systemic lupus erythematosus, and erythema multiforme-like lesions in LE (Rowell syndrome).

Annular Erythematous Plaques With Overlying Blisters in a Cluster of Jewels Pattern.

A woman in her 80s presented with erythematous, nondesquamative, annular plaques in a cluster of jewels pattern on her wrists and legs. What is your diagnosis?

Congenital bullous syphilis in a newborn: A novel approach to diagnosis using immunohistochemical staining on a blister roof.

We describe a rare presentation of congenital bullous syphilis in a premature neonate born with extensive skin desquamation. The newborn was noted to have diffuse erythema with widespread, superficial skin desquamation in addition to plantar bullae and erosions, and an absence of mucosal involvement. Immunohistochemical syphilis diagnostic staining was performed on a blister roof, highlighting a novel diagnostic approach for congenital bullous syphilis.

Newborn Girl Presenting With Erythema and Blisters.

A female child presents for 3-year follow-up with erythema, vesicles, and bullae present since birth and an increasing number of annular hyperkeratotic plaques and palmoplantar hyperkeratosis. What is your diagnosis?

Diagnostic Techniques in Autoimmune Blistering Diseases.

Autoimmune blistering diseases (AIBD) comprise a heterogeneous group of uncommon disorders of the skin and mucous membranes, characterised by antibodies targeting structural proteins within epithelial tissue and the underlying basement membrane. There can be significant overlap in clinical presentation of these diseases and accurate diagnosis relies on the detection and characterisation of relevant autoantibodies. Immunofluorescence provides the gold-standard diagnostic tool for these diseases, identifying both tissue-bound autoantibodies in biopsy material using direct immunofluorescence and circulating antibodies in serum through indirect immunofluorescence. Following advances in the identification and subsequent characterisation of numerous antigenic targets in these diseases, the development of antigen-specific tests, in particular, enzyme-linked immunosorbent assays on serum specimens, has provided a third key tool to not only identify, but also quantify AIBD autoantibodies. This quantification has proven particularly useful in monitoring disease activity and informing clinical management decisions. Accurate diagnosis of these diseases is important since optimal treatment strategies differ between them and, prognostically, some diagnoses are associated with an increased risk of malignancy. This review outlines the molecular pathology underlying the major AIBD and describes how the three principal techniques can be used in combination, to provide best practice for diagnosis and treatment monitoring.

Sap and Sun: A Case of Phytophotodermatitis.

We report a case of phytophotodermatitis caused by cow parsnip (Heracleum maximum) exposure affecting a hiker in Colorado. Phytophotodermatitis is a phototoxic skin reaction to UV-A rays after contact with photosensitizing plant substances that presents as a burning, painful rash, often with blisters. Treatment is supportive, including wound hygiene, analgesia, and anti-inflammatories. Avoiding offending plants, protecting the skin from sun, and immediate washing with soap and water after plant contact are the primary means of prevention. We have included a table and photos of plants found in the United States that can cause phytophotodermatitis. Medical providers should include phytophotodermatitis in the differential diagnosis of blistering rashes in patients who have been outdoors with possible exposure to offending plants.

A 75-Year-Old Man With Irregular Solid Components Within an Emphysematous Bulla.

CASE PRESENTATION: A 75-year-old man presented to our hospital with cough and sputum for more than a year. Eight months previously, the patient was admitted to a local hospital, and his symptoms were relieved after symptomatic treatment (expectorants and antitussives). Three months ago, he was admitted to our hospital, and his symptoms improved with antiinflammatory therapy. He had a 30-pack-years history of smoking (20 cigarettes/day) and a history of drinking (200 g liquor per day). The patient had no history of genetic disorders or cancer. He did not present with fever, dyspnea, hemoptysis or chest distress, and there was no history of weight loss since onset.

Giant and potentially malignant bullae in a dog.

Background: Primary lung neoplasms are, frequently represented by solid, solitary, or multiple formations. However, malignant cavitary lesions may be presented as lung adenocarcinomas. Those malignant lesions differ from benignant bullae by the thickness heterogeneity of its surrounding shape. Case Description: The present clinical case reports a 14-year-old female dog, of mixed breed, with an increase in the coughs frequency, fatigue, and exercise intolerance. A chest X-ray was taken, a large emphysematous cystic area was found, with thickened and irregular walls located in the left caudal pulmonary lobe, which measured 8 × 7.5 × 3 cm, and rejected the bronchial branch corresponding to the left caudal pulmonary lobe, in addition to thickening of the bronchial walls, compatible with bronchopathy. The tomographic examination of the cavity showed an air content structure, oval to round in shape, with irregular thick hyperattenuating walls measuring approximately 0.4 cm in thickness, occupying more than 30% of the left hemithorax, and pulmonary lobectomy was chosen. Histopathology confirmed the diagnosis of bronchoalveolar adenocarcinoma, with the presence of sparse areas of necrosis and dystrophic calcification. Conclusion: The present case successfully diagnosed a malignant bulae, after a surgical remove. The tomographic finds although not confirmatory, suggest a malignant component by the shape and thickness of its wall. The tomographic exam is of great importance, because only through it, it is possible to evaluate if there is lymph node or pleural involvement or the presence of small metastasis foci. There is indication for surgery and histopathological examination of the piece for a definitive diagnosis.