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GIORNALE ITALIANO DI DERMATOLOGIA E VENEREOLOGIA

A Journal on Dermatology and Sexually Transmitted Diseases


Official Journal of the Italian Society of Dermatology and Sexually Transmitted Diseases
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Giornale Italiano di Dermatologia e Venereologia 2000 April;135(2):185-9

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: English

“Herpes-like” histopathological changes in pemphigus foliaceus. Case report

Stefanato C. M., Goldberg L. J., Bhawan J.

From the Dermatopathology Section Department of Dermatology Boston University School of Medicine, Boston, MA, USA


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The histopathologic features of pemphigus foliaceus can be subtle, and range from eosinophilic spongiosis to mild acantholysis of the granular cell layer to a subcorneal vesicle. Acantholytic, dyskeratotic keratinocytes alone or associated with a subcorneal pustule may be present, depending on the age of the lesion and the degree of neutrophilic inflammation. A 52-year-old male with a history of squamous cell carcinoma of the lung presented with polycyclic, 1-3 cm erythematous crusted plaques with peripheral flaccid vesicles distributed on the scalp, chest and back. Histopathology showed a subcorneal pustule containing a few acantholytic and dyskeratotic kera-tinocytes, occasional multinucleated keratinocytic giant cells, partial thickness epidermal necrosis and superficial perivascular and interstitial infiltrate of lymphocytes and neutro-phils. Many of the acantholytic keratinocytes had smudged nuclei with intranuclear inclusions highly suggestive of herpes virus infection. However, immunoperoxidase staining was negative for herpes virus types 1 and 2, and direct immunofluorescence revealed intercellular deposition with IgG and C3 in the upper epidermis, which, in the setting of a subcorneal acantholytic dermatosis, is diagnostic of pemphigus foliaceus. This case illustrates “herpes-like” histological changes in pemphigus foliaceus, adding yet another expression to the many faces of this disease.

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