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
Pemphigus Vulgaris Bullous pemphigoid Autoantibodies against Desmosomal proteins Hemidesmosomal proteins Age 40-60 yrs 60-75 yrs Initial site Oral mucosa Lower extremities Bullae Flaccid Tense Pruritus Mild/- Nonexistent or severe Nikolsky's sign + - Mucosal involvement +(in almost all patients) - (10-40% only) HPE Suprabasal acantholytic blisters (Tombstone appearance) Q Subepidermal blisters (eosinophil-rich dermal infiltrate) DIF IgG & C3 deposits at the intercellular substance of epidermis ("Fishnet appearance")Q IgG, C3, and IgA/IgM at BM zone. IIF Circulating IgG antibodies to the intercellular substance of epidermis. Anti-BM zone antibodies IgG Rx Steroids + immunosuppressants Dapsone Gold Steroids Immunosuppressants Dapsone Postinflammatory Hyperpigmentation + - (Ref. Harrison's 19th ed. Table 55-1)
'Fishnet' IgG deposits in epidermis
Linear IgG in Deposits
Linear IgA in dermal papillae
Granular IgA in reticular dermis
Immune system