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?
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
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
Skin