Hospital course:
Infectious disease & dermatology services were consulted & felt that
this picture was most consistent with epidermolysis
bullosa or remotely staphylococcal
scalded skin. Other possibilities that were considered were impetigo,
pustular erythema toxicum and herpes
simplex virus. The vesicles on the buttocks were unroofed & sent for
testing & the patient was then started on nafcillin and acyclovir. Gram
stain of the fluid showed no cells and no organisms but subsequently grew out
coagulase negative staph. Fluid sample sent for herpes culture was negative
There were no eosinophils noted on Wright stain. The patient's rash progressed
significantly with large areas of denuded skin appearing at sites of trauma.
This was felt to be supportive of the diagnosis of epidermolysis bullosa and a
biopsy was to be performed by dermatology to confirm this diagnosis. The biopsy
is currently felt to be compatible with junctional epidermolsysis bullosa.
Epidermolysis
Bullosa Acquisita - H & E ( X25) - Subepidermal bulla
More examples of the skin lesions
OMIM
discussion
The
differential diagnosis of vesicular-bullous lesions
Tutorial on blistering diseases
Previous case discussed at MGH during senior resident presentations
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