A 17-year-old woman is brought to the physician by her parents because "she has been acting strangely" for a couple of days. Over the past 3 months, she has experienced malaise, joint pain, weight loss, and sporadic fever. The patient appears agitated, with a temperature of 38degC (101degF). Other physical findings include malar rash, erythematous-pink plaques with telangiectatic vessels, oral ulcers, and nonblanching purpuric papules on her legs. Laboratory studies show elevated levels of BUN and creatinine. The anti-double-stranded DNA antibody test is positive. Biopsy of sun-damaged lesional skin would most likely show which of the following histopathologic findings in this patient?
Acanthosis, parakeratosis, and neutrophils within the stratum corneum
Early dermal-epidermal separation mediated by eosinophils
Granular distribution of immune complexes in the basement membrane zone
Linear IgA deposits within dermal papillae
The patient exhibits signs and symptoms of systemic lupus erythematosus (SLE), a disorder characterized by a variety of autoantibodies and other immune abnormalities indicating B-cell hyperactivity. Epidermal cellular damage initiated by light or other exogenous agents causes the release of a large number of antigens, some of which may return to the skin in the form of immune complexes. Immune complexes are also formed in the skin by a reaction of local DNA with antibody that may also be deposited beneath the epidermal basement membrane zone. The other choices are not features of SLE.Diagnosis: Systemic lupus erythematosus
Skin