Interactive Case Study - August 2020

A 53-year-old male with multiple blisters on hands and forearms

Karah White MD

Amy M. Kerkvliet MD

A 53-year-old male with a history of alcohol abuse presented with multiple blisters and large erosions on his hands and forearms, which had been present for almost 2 years (Figure 1). He works outside and denies excoriating the lesions. A biopsy was performed (Figures 2-5).

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Figure 1

Figure 2

Figure 3

Figure 4

Figure 5

What is the best diagnosis?

Bullous amyloidosis

Bullous pemphigoid

Dermatitis herpetiformis

Epidermolysis bullosa acquisita

Porphyria cutanea tarda

Which of the following would be helpful in confirming the diagnosis?

Serum BP180 and BP230

Serum tissue transglutaminase antibody

Urinary metanephrine levels

Urinary uric acid levels

Urinary uroporphyrin levels

Porphyria cutanea tarda has a strong association with which condition?

Celiac disease

Graves disease

Hepatitis C virus (HCV) infection

HHV-8 infection

Lyme disease

Calonje E, Brenn T, Lazar AJ, et al. Degenerative and metabolic diseases. In: McKee's Pathology of the Skin 5^th Ed. China: Elsevier Limited; 2019. p. 559-632.
James WD, Elston DM, Treat JR, et. al. Errors in Metabolism. In: Andrews’ Diseases of the Skin 13^thEd. China: Elsevier Inc.; 2020. p. 520-522.
Patterson JW. Metabolic and storage diseases. In: Weedon’s Skin Pathology 4^th Ed. China: Churchill Livingstone Elsevier Limited; 2016. p. 593-616.
Chan CC, Lin SJ. Porphyria cutanea tarda. New England Journal of Medicine. 2011;365(12):1128.
Luzar B and McGrath JA. Inherited and autoimmune subepidermal blistering diseases. In: McKee's Pathology of the Skin 5^th Ed. China: Elsevier Limited; 2019. p. 118-170.
James WD, Elston DM, Treat JR, et. al. Chronic Blistering Dermatoses. In: Andrews’ Diseases of the Skin 13^th Ed. China: Elsevier Inc.; 2020. p. 453-474.
Maitra A. The Endocrine System. In: Robbins and Cotran’s Pathological Basis of Disease 8^th Ed. Philadelphia, PA: Saunders; 2010. p. 1159-1162.
Alpers CE. The Kidney. In: Robbins and Cotran’s Pathological Basis of Disease 8^th Ed. Philadelphia, PA: Saunders; 2010. p. 962-963.
Kumar V, Abbas AK, Fausto N, et. al. Diseases of the Immune System. In: Robbins and Cotran’s Pathological Basis of Disease 8^th Ed. Philadelphia, PA: Saunders; 2010. p. 246-247.
McAdam AJ and Sharpe AH. Infectious Diseases. In: Robbins and Cotran’s Pathological Basis of Disease 8^th Ed. Philadelphia, PA: Saunders; 2010. p. 377.

Acknowledgements

Author Profiles

Karah White

University of South Dakota, Sanford School of Medicine

Karah White, MD is a third year pathology resident at the University of South Dakota Sanford School of Medicine. She received her Doctor of Medicine from the University of South Dakota and a bachelor of science degree in chemistry and biology from the University of Sioux Falls. Her interests include dermatopathology and cytopathology.

Amy M. Kerkvliet

Sanford Pathology Clinic

Amy M. Kerkvliet, MD is a board-certified dermatopathologist and anatomic and clinical pathologist at Sanford Pathology Clinic in Sioux Falls, SD. She completed her fellowship training in dermatopathology at Geisinger Medical Center in Danville, PA. She received her Doctor of Medicine from Creighton University School of Medicine and completed pathology residency at the University of South Dakota Sanford School of Medicine.

Question:

Interactive Case Study - August 2020

Acknowledgements

Author Profiles

A 53-year-old male with multiple blisters on hands and forearms

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