Histopathologic Features Most Suggestive of Prodromal/Urticarial Bullous Pemphigoid
Vivian S Snyder, Christopher L Kinonen, Briana C Gleason, Antoinette B Thomas, Thomas L Cibull. NorthShore University HealthSystem, Evanston, IL; Diagnostic Pathology Medical Group, Sacramento, CA
Background: The clinical presentation of bullous pemphigoid (BP) can be highly variable, especially in early stages of the disease or in atypical variants such as urticarial BP. Definitive diagnosis of BP requires correlation between clinical impression, histopathology, immunofluorescence (IF), and sometimes ELISA studies. When the presentation is atypical, these patients are occasionally biopsied without concurrent IF studies. If there are features suggestive of BP, a follow-up biopsy for IF is recommended. We compared histopathologic features of cases where the initial H&E findings were suggestive of BP and follow-up IF was either positive or negative.
Design: 20 patients with skin biopsies from NorthShore University HealthSystem (2003-2012) had IF performed following an initial H&E biopsy. Patient demographics and histologic characteristics were reviewed and compared to IF findings.
Results: Patient demographics and results are listed in tables 1 and 2. None of the cases had a sub-epidermal blister.
|Total Patients||Mean Age||Female||Male|
|20||72 (range 41-90)||14 (70%)||6 (30%)|
|IF||Cases||Spongiosis||Exocytosis of Eosinophils||Dyskeratosis||Vacuolization at DEJ||Eosinophils at DEJ||Vasculitis|
|IgG, C3 at Basement Membrane||10||10||7||1||7||5||0|