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Official Journal of the Italian Society of Dermatology and Sexually Transmitted Diseases
Indexed/Abstracted in: EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,014
Online ISSN 1827-1820
Stefanato C. M., Goldberg L. J., Bhawan J.
From the Dermatopathology Section Department of Dermatology Boston University School of Medicine, Boston, MA, USA
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.