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:
'Fishnet' IgG deposits in epidermis
Linear IgG in Deposits
Linear IgA in dermal papillae
Granular IgA in reticular dermis
Ans. A. 'Fishnet' IgG deposits in epidermis Pemphigus vulgarisBullous PemphigoidAutoantibodies againstDesmosomal proteinsHemidesmosomal proteinsAge40-60 yrs60-75 yrsInitial siteOral mucosaLower extremitiesBullaeFlaccidTensePruritusMild/-Nonexistent or severeNikolsky's sign+-Mucosal involvement+(in almost all patients)- (10-40% only)HPESuprabasal acantholytic blisters (Tombstone appearance)Subepidermal blisters(eosinophil rich dermal infiltrate)DIFIgG & C3 deposits at intercellular substance of epidermis ("Fishnet appearance")IgG, C3, and IgA/IgM at BM zone.IIFCirculating IgG antibodies to intercellular substance of epidermis.Anti-BM zone antibodies IgGRxQSteroids + immunosuppressantsDapsoneGoldSteroidsImmunosuppressantsDapsonePost inflammatory Hyperpigmentation+-
Vesiculobullous (Blistering) Disorders